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* = Presenting author

P445 Perioperative use of vedolizumab seems not associated with short-term postoperative infectious complications in patients with Crohn's disease undergoing right hemicolectomy with ileocolonic anastomosis

Schils N.*1, De Buck van Overstraeten A.2, Vermeire S.1, Van Assche G.1, Wolthuis A.2, D'Hoore A.2, Ferrante M.1

1University Hospitals Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium 2University Hospitals Leuven, Department of Abdominal Surgery, Leuven, Belgium

Background

Vedolizumab (VDZ), a bowel focused anti-adhesion molecule, is effectively used in patients with Crohn's disease (CD). Since preoperative use of VDZ was recently associated with increased risk of short-term postoperative infectious complications, we assessed this risk in a cohort of patients with CD undergoing right hemicolectomy with ileocolonic anastomosis (RHC)

Methods

Chart review was performed in all patients referred for RHC between 2006 and September 2016 to identify those receiving VDZ within 14 weeks of RHC. Age- and sex-matched control patients were identified who received anti-TNF within 8 weeks of RHC, a moderate-to-high dose of steroids, or no therapy at RHC. Short-term postoperative infectious complications were evaluated within 30 days and included anastomotic leakage, surgical site and other infections. Comprehensive complication index (CCI) was calculated based on all events reported within 30 days of RHC

Results

We identified 12 patients receiving VDZ within 14 weeks of RHC (75% female, age 31 years, disease duration 12 years, previous RHC 33%). Surgery was laparoscopy-assisted in 9 patients (75%). Compared to the VDZ group, control groups did not differ significantly, except for patients in the moderate-to-high steroid dose group who had a shorter disease duration and more often used concomitant immunosuppressive therapy at RHC. No significant difference could be observed between the VDZ, steroids and no therapy group regarding postoperative complications. Although patients in the selected anti-TNF group more often experienced non-infectious complications including prolonged ileus, venous thrombosis and urinary retention [67% vs. 8%, Odds ratio 22.22 (95% CI 2.05–250.00), p=0.009], a similar infectious complication rate [58% vs. 50%, 1.40 (0.28–6.99), p=0.682] and a similar CCI [10.5 (8.7–28.8) vs. 4.4 (0.0–22.2), p=0.128] was observed. The postoperative hospitalization stay tended to be higher in this anti-TNF group [9 (6–10) vs. 6 (4–10) days in the VDZ group, p=0.078]. CCI and postoperative hospitalization stay were not significantly different between the other treatment categories

Figure 1. Short-term postoperative complications.

Conclusion

In this small matched case-control study with CD patients undergoing RHC, we could not observe an increased risk of postoperative (infectious) complications in patients receiving VDZ. On the contrary, compared to anti-TNF therapy a decreased risk of postoperative non-infectious complications could be observed. Larger multi-center data sets are required to provide more evidence of a save use of VDZ in the preoperative setting