The Impact of Peri-operative Anti-TNF Treatment on Anastomosis-Related Complications in Crohn's Disease Patients. A Critical Review

Tumor necrosis factor (TNF)alpha is a cytokine exerting pleiotropic effects on critical cell functions and, most importantly, is the main regulator of pro-inflammatory cytokine production and a key player in the pathophysiology of numerous autoimmune diseases, including Crohn's disease. TNF alpha became a therapeutic target and TNF alpha blocking agents are currently used in the treatment of inflammatory diseases. Beyond the therapeutic benefits deriving from TNF alpha neutralization, amendments in the cellular functions of the immune system may as well induce potent immunosuppressive effects. An attenuated immune response may compromise the intestinal healing ability, thus leading to weaker anastomosis and increased risk of anastomotic leak and septic complications. This hypothesis raises great concerns about the safety of perioperative administration of anti-TNF and has been the endpoint of numerous studies. The aim of this review is to critically evaluate the evidence regarding the role of TNF alpha in anastomosis related complications after abdominal surgery in Crohn's disease patients.