Intest Res  
Comparison of time until elective intestinal resection regarding previous anti-tumor necrosis factor exposure: a Brazilian study on patients with Crohn’s disease
Paulo Gustavo Kotze1, Daniela Oliveira Magro2, Barbara Saab1, Mansur Paulo Saab1, Lilian Vital Pinheiro2, Marcia Olandoski3, Maria de Lourdes Setsuko Ayrizono2, Carlos Augusto Real Martinez2, Claudio Saddy Rodrigues Coy2
1Colorectal Surgery Unit, IBD Outpatients Clinic, Cajuru University Hospital, Catholic University of Parana (PUCPR), Curitiba,
2Colorectal Surgery Unit, Department of Surgery, Campinas State University (UNICAMP), Campinas, 3Department of Biostatistics, Catholic University of Parana (PUCPR), Curitiba, Brazil
Correspondence to: Paulo Gustavo Kotze, Colorectal Surgery Unit, IBD Outpatients Clinic, Cajuru University Hospital, Catholic University of Parana (PUCPR), Rua Maua 682, Curitiba 80030-200, Brazil. Tel: +55-41-3022-5500, Fax: +55-41-3243-0033, E-mail:
Received: June 6, 2017; Revised: July 27, 2017; Accepted: August 3, 2017; Published online: November 8, 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 ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background/Aims: The use of anti-tumor necrosis factor (anti-TNF) agents seems to reduce surgical rates and delay surgical procedures in prospective trials and population-based studies in the management of Crohn’s disease (CD). This study aimed to identify whether preoperative anti-TNF agents influence the time from diagnosis to surgery. Methods: An observational retrospective cohort study was conducted on patients with CD submitted to intestinal resections due to complications or medical therapy failure in a period of 7 years. The patients were allocated into 2 groups according to their previous exposure to anti-TNF agents in the preoperative period. Epidemiological aspects regarding age at diagnosis, smoking, perianal disease, and preoperative conventional therapy were considered. A Kaplan-Meier survival analysis was used to outline possible differences between the groups regarding the time to surgery. Results: A total of 123 patients were included (71 and 52 with and without previous exposure to biologics, respectively). The overall time to surgery was 108±6.9 months (maximum, 276 months). The survival estimation revealed no difference in the mean time to intestinal resection between the groups (99.78±10.62 months in the patients without and 114.01±9.07 months in those with previous anti-TNF use) (log-rank P=0.35). There was no significant difference in the time to surgery regarding perianal CD (P=0.49), smoking (P=0.63), preoperative azathioprine (P=0.073) and steroid use (P=0.58). Conclusions: The time from diagnosis to surgery was not influenced by the preoperative use of anti-TNF therapy in this cohort of patients.
Keywords: Crohn disease; Tumor necrosis factor-alpha; Surgical procedures, operative; Survival analysis

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