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P265. Preoperative infliximab therapy and postoperative complications after proctocolectomy with ileum pouch anal anastomosis (IPAA)

E.J. Eshuis, R. al-Saady, P.C.F. Stokkers, W.A. Bemelman

Academic Medical Center, Amsterdam, The Netherlands

Aim: Medical refractory ulcerative colitis is best treated by means of a proctocolectomy with ileum pouch anal anastomosis (IPAA). In 2006, infliximab (IFX) was approved for treatment of steroid dependent ulcerative colitis, and since then this therapy is applied as rescue therapy in order to prevent a proctocolectomy. However, several studies showed an increased complication rate in patients with previous IFX treatment compared to patients without IFX. This raised the question whether it is safe to perform a 1-stage operation in case of preoperative IFX therapy, or if patients with prior IFX therapy should always receive a 2-stage procedure. Aim of this study was to assess the postoperative complication rate of patients undergoing proctocolectomy with IPAA comparing patients with and without IFX therapy in a tertiary referral center.

Methods: Retrospectively, all pouch procedures from 2006 until 2009 were assessed. Inclusion criteria were ulcerative colitis and therapy refractoriness; excluded were patients with other diagnoses or other indications for surgery. Postoperative complications and IFX use were assessed.

Results: 72 patients were included; 33 underwent a 1-stage procedure (proctocolectomy with IPAA) and 39 had a 2-stage procedure (emergency colectomy and later completion proctectomy with IPAA). In the 1-stage procedure patient characteristics were comparable. Of those, 21 patients had preoperative IFX therapy. Total and infectious complications were not different. However more IFX-treated patients had anastomotic leakage (4/21 vs. 0/12; risk difference (RD) 19%; 95% CI: 2 to 36) and non-infectious complications (8/21 vs. 1/12; RD 30%; 95% CI: 4 to 56). Although several patient characteristics in the 2-stage groups were not comparable, complication rates were similar in these 17 IFX and 22 non-IFX patients (total number of patients with complications: 8/17 vs. 8/22; RD 11%; 95% CI: −20 to 42; infectious complications: 6/17 vs. 5/22; RD 12%; 95% CI: −16 to 41; non-infectious complications 6/17 vs. 3/22; RD 21%; 95% CI −5 to 49).

Conclusion: This was a small study. However, the data support the performance of a 2-stage procedure in all patients with prior IFX therapy.