Effect of postoperative non-steroidal anti-inflammatory drugs on anastomotic leakage after pancreaticoduodenectomy

Yoon, Seo-Yeon; Kim, Hyerin; Cho, Hye Yeon; Lee, Ho-Jin; Kim, Hongbeom; Lee, Hyung Chul; Jang, Jin‐Young

doi:10.4097/kja.21096

Cited by 4 publications

(4 citation statements)

References 34 publications

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“…The study exploring postoperative NSAIDs with the highest number of PD patients found that NSAIDs were associated with significantly greater CR-POPF [80]. In smaller studies considering non-selective NSAIDs, no difference in CR-POPF was reported after PD [81][82][83][84], even in high-risk (>40% acinar cell density) patients [76].…”

Section: Analgesiamentioning

confidence: 99%

“…As such, the effect of nonselective NSAIDs on particular pancreatectomy patients requires further clarification in larger, cohort-specific RCTs. Moreover, as non-selective NSAIDs may impair angiogenesis and collagen deposition critical for wound healing, they should be used cautiously, with alternatives preferred if possible [80]. This also applies to COX-2 selective inhibitors associated with CR-POPF, even at low doses [81].…”

Section: Analgesiamentioning

confidence: 99%

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Non-Surgical Interventions for the Prevention of Clinically Relevant Postoperative Pancreatic Fistula—A Narrative Review

Rykina-Tameeva,

Samra,

Sahni

et al. 2023

Cancers

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Clinically relevant postoperative pancreatic fistula (CR-POPF) is the leading cause of morbidity and mortality after pancreatic surgery. Post-pancreatectomy acute pancreatitis (PPAP) has been increasingly understood as a precursor and exacerbator of CR-POPF. No longer believed to be the consequence of surgical technique, the solution to preventing CR-POPF may lie instead in non-surgical, mainly pharmacological interventions. Five databases were searched, identifying eight pharmacological preventative strategies, including neoadjuvant therapy, somatostatin and its analogues, antibiotics, analgesia, corticosteroids, protease inhibitors, miscellaneous interventions with few reports, and combination strategies. Two further non-surgical interventions studied were nutrition and fluids. New potential interventions were also identified from related surgical and experimental contexts. Given the varied efficacy reported for these interventions, numerous opportunities for clarifying this heterogeneity remain. By reducing CR-POPF, patients may avoid morbid sequelae, experience shorter hospital stays, and ensure timely delivery of adjuvant therapy, overall aiding survival where prognosis, particularly in pancreatic cancer patients, is poor.

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Section: Analgesiamentioning

confidence: 99%

Section: Analgesiamentioning

confidence: 99%

Non-Surgical Interventions for the Prevention of Clinically Relevant Postoperative Pancreatic Fistula—A Narrative Review

Rykina-Tameeva,

Samra,

Sahni

et al. 2023

Cancers

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“…However, the overall incidence of HL was too low (1.9%) to allow for the role of NSAIDs to be analyzed as a risk factor for postoperative HL using binary logistic regression analysis. In addition, NSAID use was not a risk factor for POPF in that study [ 24 ].…”

mentioning

confidence: 98%

“…Yoon et al [ 24 ] retrospectively investigated the association between postoperative NSAID use and clinically relevant postoperative anastomotic leakage (postoperative pancreatic fistula [POPF] or hepatojejunostomy anastomotic leakage [HL]), in > 4,000 patients. The authors found a higher incidence of HL within the first 5 postoperative days in the group that received NSAIDs postoperatively (OR: 3.11, 95% CI [1.86, 5.21]).…”

mentioning

confidence: 99%

NSAIDs, are they dangerous for pancreatic surgery?

Lee

2022

Korean J Anesthesiol

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Appropriately controlling acute postoperative pain is associated with improved recovery and postoperative outcomes. Postoperative pain should be controlled in the most effective and safest manner with the fewest side effects possible. Multimodal analgesia is a combination of various with different mechanisms of action that have additive or synergistic effects when taken together [1]. This allows for a lower total analgesic dose and fewer side effects, opioid requirement. Several drugs are currently used for multimodal treatment strategies, including nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, gabapentinoids, N-methyl-D-aspartate receptor antagonists, glucocorticoids, lidocaine, alpha 2 agonists, and local anesthetics for regional blocks.NSAIDs are effective non-opioid analgesics that are widely used in the perioperative setting. The primary mechanism of action is the inhibition of the cyclooxygenase (COX) enzyme, which blocks the inflammatory response by preventing the formation of prostaglandins. NSAIDs are categorized on the basis of their selectivity for COX-1 and COX-2. Non-selective NSAIDs block both enzymes, and the side effects of these drugs are mainly due to COX-1 inhibition, which is associated with a disturbance in vascular homeostasis [2].The side effects of NSAIDs on renal function [3-6], cardiac events [7-9], perioperative bleeding [10][11][12], wound healing [13,14], and gastrointestinal events [15] have been assessed, with some concerning findings. However, the results are controversial and the evidence is not conclusive.NSAIDs have been shown to have a strong analgesic effect similar to opioids [16-19], with similar acute postoperative pain control. This makes them suitable for reducing opioid consumption and thus improve bowel function [17,20]. However, safety concerns regarding postoperative anastomotic complications have recently been raised. Since NSAIDs can impair collagen deposition and angiogenesis, the strength of anastomosis is thus decreased [21,22]. Kotagal et al. [16], in their study of 398,752 patients undergoing gastrointestinal surgery, found that the administration of ketorolac was associated with an increased risk of readmission and reintervention due to anastomosis complications (odds ratio [OR]: 1.20, 95% CI [1.06, 1.36]). According to another large-scale retrospective cohort study, NSAIDs were found to increase the risk of anastomotic leaks (OR: 1.70, 95% CI [1.11, 2.68], P = 0.01) in patients undergoing bariatric or colorectal surgery [23]. Yoon et al. [24] retrospectively investigated the association between postoperative NSAID use and clinically relevant postoperative anastomotic leakage (postoperative pancreatic fistula [POPF] or hepatojejunostomy anastomotic leakage [HL]), in > 4,000 patients. The authors found a higher incidence of HL within the first 5 postoperative days in the group that received NSAIDs postoperatively (OR: 3.11, 95% CI [1.86, 5.21]). However, the overall incidence of HL was too low (1.9%) to allow for the role of NSAIDs to be analyz...

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Impact of postoperative NSAIDs (IV-PCA) use on short-term outcomes after laparoscopic gastrectomy for the patients of gastric cancer

et al. 2022

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Effect of postoperative non-steroidal anti-inflammatory drugs on anastomotic leakage after pancreaticoduodenectomy

Abstract: This article has been accepted for publication and has undergone full peer review but has notbeen through the copyediting, typesetting, pagination, and proofreading processes, which may lead to differences between this version and the version of record.

Cited by 4 publications

References 34 publications

Non-Surgical Interventions for the Prevention of Clinically Relevant Postoperative Pancreatic Fistula—A Narrative Review

Non-Surgical Interventions for the Prevention of Clinically Relevant Postoperative Pancreatic Fistula—A Narrative Review

NSAIDs, are they dangerous for pancreatic surgery?

Impact of postoperative NSAIDs (IV-PCA) use on short-term outcomes after laparoscopic gastrectomy for the patients of gastric cancer

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