BACKGROUND The optimal treatment of perianal fistulizing Crohn’s disease (PFCD) is unknown. We performed a systematic review with meta-analysis to compare combined surgical intervention and anti-TNF therapy (combined therapy) vs. either therapy alone. METHODS MEDLINE, EMBASE, and Cochrane databases were searched systematically through December 2023. Surgical intervention was defined as an exam under anesthesia ± setons. We calculated weighted risk ratios (RR) with 95% confidence intervals (CI) for our co-primary outcomes: fistula response and healing, defined clinically as a reduction in fistula drainage or number of draining fistulas and fistula closure respectively. RESULTS Thirteen studies were analysed: 515 patients treated with combined therapy, 330 patients with surgical intervention and 406 patients with anti-TNF therapy with follow-up between 10 weeks and 3 years. Fistula response (RR 1.10; 95% CI, 0.93-1.30, p=0.28) and healing (RR 1.06; 95% CI, 0.86-1.31, p=0.58) was not significantly different when comparing combined therapy with anti-TNF therapy alone. In contrast, combined therapy was associated with significantly higher rates of fistula response (1.25; 95% CI, 1.10-1.41, p<0.001) and healing (RR 1.17; 95% CI, 1.00-1.36, p=0.05) compared with surgical intervention alone. Our results remained stable when limiting to studies that assessed outcomes within 1 year and studies where <10% of patients underwent fistula closure procedures. CONCLUSION Combined surgery and anti-TNF therapy was not associated with improved PFCD outcomes compared with anti-TNF therapy alone. Due to an inability to control for confounding and small study sizes, future, controlled trials are warranted to confirm these findings.

中文翻译：

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药物和手术联合治疗能否改善克罗恩病患者的肛周瘘结局？系统回顾和荟萃分析

背景 肛周瘘管克罗恩病（PFCD）的最佳治疗方法尚不清楚。我们通过荟萃分析进行了系统评价，以比较联合手术干预和抗 TNF 治疗（联合治疗）与单独治疗的情况。方法 系统检索截至 2023 年 12 月的 MEDLINE、EMBASE 和 Cochrane 数据库。手术干预定义为麻醉±挂线下的检查。我们计算了我们的共同主要结果的加权风险比 (RR) 和 95% 置信区间 (CI)：瘘管反应和愈合，临床上分别定义为瘘管引流或引流瘘管数量和瘘管闭合的减少。结果 分析了 13 项研究：515 名患者接受联合治疗，330 名患者接受手术干预，406 名患者接受抗 TNF 治疗，随访时间为 10 周至 3 年。联合治疗与单独抗 TNF 治疗相比，瘘管反应（RR 1.10；95% CI，0.93-1.30，p=0.28）和愈合（RR 1.06；95% CI，0.86-1.31，p=0.58）没有显着差异。相反，与手术治疗相比，联合治疗的瘘管反应率（1.25；95% CI，1.10-1.41，p＜0.001）和愈合率（RR 1.17；95% CI，1.00-1.36，p=0.05）显着升高。单独干预。当仅限于评估 1 年内结果的研究和 <10% 的患者接受瘘管闭合手术的研究时，我们的结果保持稳定。结论 与单独抗 TNF 治疗相比，联合手术和抗 TNF 治疗与改善 PFCD 结局无关。由于无法控制混杂因素和小研究规模，未来有必要进行对照试验来证实这些发现。