title: The impact of peri-operative anti-TNF treatment on anastomosis-related complications in Crohn's disease patients. A critical review.
abstract: BACKGROUND
  Tumor necrosis factor (TNF)α 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.
  
  
  METHODS
  TNFα became a therapeutic target and TNFα blocking agents are currently used in the treatment of inflammatory diseases. Beyond the therapeutic benefits deriving from TNFα 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.
  
  
  RESULTS
  This hypothesis raises great concerns about the safety of perioperative administration of anti-TNF and has been the endpoint of numerous studies.
  
  
  CONCLUSIONS
  The aim of this review is to critically evaluate the evidence regarding the role of TNFα in anastomosis related complications after abdominal surgery in Crohn's disease patients.
authors.affiliation: Second Department of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Papaconstantinou
authors.forename: Christos
authors.initials: C
authors.lastname: Zeglinas
authors.forename: Maria
authors.initials: M
authors.lastname: Gazouli
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Nastos
authors.forename: Anneza
authors.initials: A
authors.lastname: Yiallourou
authors.forename: Apostolos
authors.initials: A
authors.lastname: Papalois
authors.forename: Charalambos
authors.initials: C
authors.lastname: Tzathas
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology*; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D003424:Crohn Disease / Q000188:drug therapy / Q000601:surgery*; D005402:Fistula / Q000209:etiology*; D006801:Humans; D000069285:Infliximab; D019990:Perioperative Care; D012086:Reoperation; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab