Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Diseases of the Colon & Rectum
Published in: Diseases of the Colon & Rectum 8/2008

01-08-2008 | Original Contribution

Infliximab in Ulcerative Colitis is Associated with an Increased Risk of Postoperative Complications After Restorative Proctocolectomy

Authors: I. J. Mor, M.D., F.R.A.C.S., J. D. Vogel, M.D., A. da Luz Moreira, M.D., B. Shen, M.D., J. Hammel, M.S., F. H. Remzi, M.D.

Published in: Diseases of the Colon & Rectum | Issue 8/2008

Login to get access

Abstract

Purpose

Little data exist regarding infliximab use in surgical decision making and postoperative complications in ulcerative colitis. Our goals were to determine the rate of postoperative complications in infliximab-treated ulcerative colitis patients undergoing restorative proctocolectomy and to determine whether three-stage procedures are more often necessary.

Methods

We studied a group of infliximab-treated patients and matched control subjects who underwent two-stage restorative proctocolectomy between 2000 and 2006. Postoperative complications were compared. In addition, the rate of three-stage procedures was compared between all infliximab- and noninfliximab-treated patients.

Results

A total of 523 restorative proctocolectomies were performed. In the infliximab group, there were 46 two-stage and 39 three-stage procedures. Covariate-adjusted odds of early complication for the inflixmab group was 3.54 times that of controls (P = 0.004; 95 percent confidence interval (CI), 1.51–8.31). The odds of sepsis were 13.8 times greater (P = 0.011; 95 percent CI, 1.82–105) and the odds of late complication were 2.19 times greater (P = 0.08; 95 percent CI, 0.91–5.28) for infliximab. The odds of requirement for three-stage procedures was 2.07 times greater in the infliximab group (P = 0.011; 95 percent CI, 1.18–3.63).

Conclusions

Infliximab increases the risk of postoperative complications after restorative proctocolectomy and has altered the surgical approach to ulcerative colitis. Potential benefits of infliximab should be balanced against these risks.
Literature
1.
Su C, Salzberg BA, Lewis JD, et al. Efficacy of anti-tumor necrosis factor therapy in patients with ulcerative colitis. Am J Gastroenterol 2002;97:2577–84.PubMedCrossRef
2.
Chey WY, Hussain A, Ryan C, Potter GD, Shah A. Infliximab for refractory ulcerative colitis. Am J Gastroenterol 2001;96:2373–81.PubMedCrossRef
3.
Cottone M, Mocciaro F, Modesto I. Infliximab and ulcerative colitis. Expert Opin Biol Ther 2006;6:401–8.PubMedCrossRef
4.
Jarnerot G, Hertervig E, Friis-Liby I, et al. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology 2005;128:1805–11.PubMedCrossRef
5.
Kohn A, Prantera C, Pera A, Cosintino R, Sostegni R, Daperno M. Anti-tumour necrosis factor alpha (infliximab) in the treatment of severe ulcerative colitis: result of an open study on 13 patients. Dig Liver Dis 2002;34:626–30.PubMedCrossRef
6.
Probert CS, Hearing SD, Schreiber S, et al. Infliximab in moderately severe glucocorticoid resistant ulcerative colitis: a randomised controlled trial. Gut 2003;52:998–1002.PubMedCrossRef
7.
Sands BE, Tremaine WJ, Sandborn WJ, et al. Infliximab in the treatment of severe, steroid-refractory ulcerative colitis: a pilot study. Inflamm Bowel Dis 2001;7:83–8.PubMedCrossRef
8.
Ochsenkuhn T, Sackmann M, Goke B. Infliximab for acute, not steroid-refractory ulcerative colitis: a randomized pilot study. Eur J Gastroenterol Hepatol 2004;16:1167–71.PubMedCrossRef
9.
Rutgeerts P, Sandborn WJ, Feagan BG, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med 2005;353:2462–76.PubMedCrossRef
10.
Colombel JF, Loftus EV Jr, Tremaine WJ, et al. Early postoperative complications are not increased in patients with Crohn’s disease treated perioperatively with infliximab or immunosuppressive therapy. Am J Gastroenterol 2004;99:878–83.PubMedCrossRef
11.
Marchal L, D’Haens G, Van Assche G, et al. The risk of post-operative complications associated with infliximab therapy for Crohn’s disease: a controlled cohort study. Aliment Pharmacol Ther 2004;19:749–54.PubMedCrossRef
12.
Selvasekar CR, Cima RR, Larson DW, et al. Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis. J Am Coll Surg 2007;204:956–63.PubMedCrossRef
13.
Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. BMJ 1978;2:85–8.PubMedCrossRef
14.
Fazio VW, Ziv Y, Church JM, et al. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg 1995;222:120–7.PubMedCrossRef
15.
Fazio VW, O’Riordain MG, Lavery IC, et al. Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 1999;230:575–84.PubMedCrossRef
16.
Shen EH, Das KM. Current therapeutic recommendations: infliximab for ulcerative colitis. J Clin Gastroenterol 2004;38:741–5.PubMedCrossRef
17.
Colombel JF, Loftus EV Jr, Tremaine WJ, et al. The safety profile of infliximab in patients with Crohn’s disease: the mayo clinic experience in 500 patients. Gastroenterology 2004;126:19–31.PubMedCrossRef
18.
Lichtenstein GR, Feagan B, Cohen RD, et al. Serious infections and mortality in association with therapies for Crohn’s disease: TREAT regi stry. Clin Gastroenterol Hepatol 2006;4:621–30.PubMedCrossRef
19.
Kapsoritakis AN, Koukourakis MI, Sfiridaki A, et al. Mean platelet volume: a useful marker of inflammatory bowel disease activity. Am J Gastroenterol 2001;96:776–81.PubMedCrossRef
20.
Vermeire S, Van Assche G, Rutgeerts P. Laboratory markers in IBD: useful, magic or unnecessary toys. Gut 2006;55:426–31.PubMedCrossRef
21.
Danese S, Motte Cd Cde L, Fiocchi C. Platelets in inflammatory bowel disease: clinical, pathogenic and therapeutic implications. Am J Gastroenterol 2004;99:938–45.PubMedCrossRef
1.
Rutgeerts P, Sandborn WJ, Feagan BG, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med 2005;353:2462–76.PubMedCrossRef
2.
Strong SA, Fazio VW. Surgical treatment of inflammatory bowel disease. Curr Opin Gastroenterol 1999;15:326–30.PubMedCrossRef
3.
Sandborn WJ, Loftus EV. Balancing the risks and benefits of infliximab in the treatment inflammatory bowel disease. Gut 2004;53:780–2.PubMedCrossRef
4.
Colombel JF, Loftus EV, Tremaine WJ, et al. The safety profile of infliximab in patients with Crohn’s disease: the Mayo Clinic experience in 500 patients. Gastroenterology 2004;126:19–31.PubMedCrossRef
5.
Colombel JF, Loftus EV, Tremaine WJ, et al. Early postoperative complications were not increased in patients with Crohn’s disease treated perioperatively with infliximab or immunosuppressive therapy. Am J Gastroenterol 2004;99:878–83.PubMedCrossRef
6.
Marchal L, D’Haens G, Van Assche G, et al. The risk of post-operative complications associated with infliximab therapy for Crohn’s disease: a controlled cohort study. Aliment Pharmacol Ther 2004;19:749–54.PubMedCrossRef
7.
Brzezinski A, Amstrong L, Alvarez del Real G, et al. Infliximab does not increase the risk of complications in the peri-operative period in patients with Crohn’s disease [abstract]. Gastroenterology 2002;122:A617.
8.
Lichtenstein GR, Feagan BG, Cohen RD, et al. Serious infections and mortality in association with therapies for Crohn’s disease: TREAT registry. Clin Gastroenterol Hepatol 2006;4:621–30.PubMedCrossRef
9.
Selvasekar CR, Cima RR, Larson DW, et al. Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis. J Am Coll Surg 2007;204:956–63.PubMedCrossRef
10.
Schluender SJ, Ippoliti A, Dubinsky M, et al. Does infliximab influence surgical morbidity of ileal pouch-anal anastomosis in patients with ulcerative colitis. Dis Colon Rectum 2007;50:1747–53.PubMedCrossRef
1.
Colombel JF, Loftus EV, Tremaine WJ, et al. Early postoperative complications were not increased in patients with Crohn’s disease treated perioperatively with infliximab or immunosuppressive therapy. Am J Gastroenterol 2004;99:878–83.PubMedCrossRef
2.
Marchal L, D’Haens G, Van Assche G, et al. The risk of post-operative complications associated with infliximab therapy for Crohn’s disease: a controlled cohort study. Aliment Pharmacol Ther 2004;19:749–54.PubMedCrossRef
3.
Brzezinski A, Amstrong L, Alvarez del Real G, et al. Infliximab does not increase the risk of complications in the peri-operative period in patients with Crohn’s disease [abstract]. Gastroenterology 2002;122:A617.
4.
Selvasekar CR, Cima RR, Larson DW, et al. Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis. J Am Coll Surg 2007;204:956–63.PubMedCrossRef
5.
Mack DR, Langton C, Markowitz J, et al. Laboratory values for children with newly diagnosed inflammatory bowel disease. Pediatrics 2007;119:113–9.CrossRef
6.
Kapsoritakis AN, Koukourakis MI, Sfiridaki A, et al. Mean platelet volume: a useful marker of inflammatory bowel disease activity. Am J Gastroenterol 2001;96:776–81.PubMedCrossRef
Metadata
Title
Infliximab in Ulcerative Colitis is Associated with an Increased Risk of Postoperative Complications After Restorative Proctocolectomy
Authors
I. J. Mor, M.D., F.R.A.C.S.
J. D. Vogel, M.D.
A. da Luz Moreira, M.D.
B. Shen, M.D.
J. Hammel, M.S.
F. H. Remzi, M.D.
Publication date
01-08-2008
Publisher
Springer-Verlag
Published in
Diseases of the Colon & Rectum / Issue 8/2008
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-008-9364-7

Other articles of this Issue 8/2008

Diseases of the Colon & Rectum 8/2008 Go to the issue

Letter to the Editor

Sphincter-Sparing Surgical Alternatives for Chronic Anal Fissure: the Place of Fissurotomy

Original Contribution

Risk Factors for Surgical Recurrence after Ileocolic Resection of Crohn’s Disease

Self-Assessment Quiz

Self-Assessment Quiz: Answers, Critiques, and References

Current Status

Review of Fecal Biomarkers in Inflammatory Bowel Disease

Selected Abstracts

Selected abstracts – August 2008

Original Contribution

Complication Rates After Hartmann’s Reversal: Open vs. Laparoscopic Approach