Anti‐inflammatory Effects of Enhanced Recovery Programs on Early‐Stage Colorectal Cancer Surgery

Abstract

The effects of ERP on GI recovery are correlated with the compliance of ERP and could be mediated at least in part by mPGES1, HPGDS and COX-2. Furthermore, mPGES1 shows promise as a therapeutic target to further reduce POI duration among ERP patients.

Nonsteroidal anti‐inflammatory drugs reduce the time to recovery of gut function after elective colorectal surgery: a systematic review and meta‐analysis

“…A key consideration for this research is whether these results are clinically relevant within a modern ERAS framework of perioperative care. Current evidence suggests that, despite the use of ERAS, POI still occurs in as many as 25–30% of patients after elective colorectal surgery . Venara et al .…”

“… recently looked at the expression of COX‐2 mRNA in pathology specimens from patients who underwent elective colorectal surgery and found that ERAS patients had significant reductions in COX‐2 mRNA expression compared with patients who did not follow an ERAS pathway. Of particular interest was that laparoscopic surgery, compared with laparotomy, did not significantly reduce levels of COX‐2 mRNA . This suggests that there may be additional benefits of short term COX‐2 selective NSAID use in additional to core ERAS principles.…”

“…A key consideration for this research is whether these results are clinically relevant within a modern ERAS framework of perioperative care. Current evidence suggests that, despite the use of ERAS, POI still occurs in as many as 25-30% of patients after elective colorectal surgery [48][49][50]. Venara et al [50] recently looked at the expression of COX-2 mRNA in pathology specimens from patients who underwent elective colorectal surgery and found that ERAS patients had significant reductions in COX-2 mRNA expression compared with patients who did not follow an ERAS pathway.…”

“…Current evidence suggests that, despite the use of ERAS, POI still occurs in as many as 25-30% of patients after elective colorectal surgery [48][49][50]. Venara et al [50] recently looked at the expression of COX-2 mRNA in pathology specimens from patients who underwent elective colorectal surgery and found that ERAS patients had significant reductions in COX-2 mRNA expression compared with patients who did not follow an ERAS pathway. Of particular interest was that laparoscopic surgery, compared with laparotomy, did not significantly reduce levels of COX-2 mRNA [50].…”

Systematic Review and Meta-analysis of Nonsteroidal Anti-inflammatory Drugs to Improve GI Recovery After Colorectal Surgery

“…Enhanced recovery protocols may improve ileus through fast-track care pathways which aim to maintain normal organ function and reduce the postoperative stress response. 6 Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended by enhanced recovery protocols after elective colorectal surgery. 7 They are desirable for avoiding undesirable effects of opioid analgesia, such as constipation, sedation and respiratory depression.…”