Intest Res  
Preoperative use of anti-tumor necrosis factor therapy in Crohn’s disease: promises and pitfalls
Paulo Gustavo Kotze1, Subrata Ghosh2, Willem A. Bemelman3, Remo Panaccione4
1Colorectal Surgery Unit, Cajuru University Hospital, Catholic University of Paraná, Curitiba, Brazil, 2Institute of Translational Medicine, University of Birmingham, Edgbaston, Birmingham, UK, 3Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands, 4Inflammatory Bowel Disease Unit, University of Calgary, Alberta, Canada
Correspondence to: Paulo Gustavo Kotze, Colorectal Surgery Unit, Cajuru University Hospital, Catholic University of Paraná, Rua Mauá 682, Curitiba 80030-200, Brazil. Tel: +55-41-3022-5500, Fax: +55-41-3243-0033, E-mail: pgkotze@hotmail.com
Received: December 26, 2016; Revised: January 19, 2017; Accepted: January 19, 2017; Published online: March 21, 2017.
© Korean Association for the Study of Intestinal Diseases. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Recent advances in medical and surgical therapy were achieved during the last two decades in the management of Crohn’s disease (CD). Anti-tumor necrosis factor (anti-TNF) agents are widely used worldwide. However, a significant proportion of patients still need surgical resections. The impact of previous exposure to these agents on the perioperative and postoperative outcomes is still controversial. In this critical review, we aimed to position the strategy of intentional preoperative use of anti-TNF agents in the management of CD. The indications and contraindications for this strategy are detailed, and despite scarce evidence, the possible advantages and disadvantages of the intentional use of anti-TNF agents before abdominal surgery in CD are discussed.
Keywords: Crohn disease; Tumor necrosis factor-alpha; Preoperative care


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