Effect of Prednisolone on Local and Systemic Response in Laparoscopic vs. Open Colon Surgery

Vignali, Andrea; Palo, S. Di; Orsenigo, Elena; Ghirardelli, Luca; Radaelli, Giovanni; Staudacher, C.

doi:10.1007/dcr.0b013e31819ef69d

Cited by 37 publications

(45 citation statements)

References 32 publications

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“…Indeed these factors, to an extent, limit the generalisability of the results of the present study. However, the exclusion of the 6 studies which included a small proportion of patients without malignant disease would have significantly reduced the power of the present meta-analysis [30,[35][36][37]39]. A significant degree of heterogeneity was reported in the analysis of postoperative IL-6 and CRP.…”

Section: Discussionmentioning

confidence: 99%

“…The remaining 11 randomised controlled trials including 474 patients were included in the review (Table 1) [30][31][32][33][34][35][36][37][38][39][40].…”

Section: Study Selection Processmentioning

confidence: 99%

“…Of the included studies, 3 including 139 patients were in colorectal surgery [38][39][40], 4 including 156 patients were in oesophageal surgery [30,32,[34][35], and 4 including 179 patients were in hepatic surgery [31,33,[36][37]. Of the 474 included patients, 436 ( 92%) had surgery for gastrointestinal cancer while 38 (8%) from 6 studies had surgery for benign gastrointestinal disease but were included in the meta-analysis [31,[36][37][38]40].…”

Section: Study Selection Processmentioning

confidence: 99%

“…Of the included studies, 6 including 206 patients reported the impact of preoperative corticosteroids on postoperative CRP following surgery for gastrointestinal cancer and were included in meta-anaysis ( Figure 3) [31,35,[37][38][39][40]. Preoperative corticosteroids were significantly associated with lower serum concentrations of CRP following surgery for gastrointestinal cancer on postoperative day 3 (p<0.001), and day 7 (p=0.04), but not postoperative day 1 (p=0.09) or day 2 (p=0.11).…”

Section: Impact Of Preoperative Corticosteroids On Il-6mentioning

confidence: 99%

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The impact of preoperative corticosteroids on the systemic inflammatory response and postoperative complications following surgery for gastrointestinal cancer: A systematic review and meta-analysis

McSorley

Horgan

McMillan

2016

Critical Reviews in Oncology/Hematology

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. (2016) The impact of preoperative corticosteroids on the systemic inflammatory response and postoperative complications following surgery for gastrointestinal cancer: a systematic review and meta-analysis. Critical Reviews in Oncology Hematology, 101, pp. 139-150. (doi:10.1016Hematology, 101, pp. 139-150. (doi:10. /j.critrevonc.2016 This is the author's final accepted version.There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it.http://eprints.gla.ac.uk/117484/ This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. This meta-analysis examined the impact of preoperative corticosteroids on interleukin 6 (IL-6), C-reactive protein (CRP), and complications following surgery for gastrointestinal cancer. Methods:A systematic review was performed using appropriate keywords. Random-effects metaanalysis was performed.Results:11 RCTs with 474 patients, were included. Corticosteroids were significantly associated with lower IL-6 on postoperative day 1 (mean difference -148 pg/mL, 95% CI -205 to -92, p<0.001), 2 (-33 pg/mL, 95% CI -58 to -8, p=0.01), and 3 (-31 pg/mL, 95% CI -52 to -11, p=0.002), lower CRP on day 3 (-45 mg/L, 95% CI -68 to -21, p<0.001), and 7 (-14 mg/L, 95% CI -27 to -1, p=0.04), and fewer postoperative infective complications (OR 0.47, 95% CI 0.26 to 0.83, p=0.01).2 Conclusion:Corticosteroids were associated with reduction in the postoperative systemic inflammatory response and complications following surgery for gastrointestinal cancer.

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Section: Discussionmentioning

confidence: 99%

“…The remaining 11 randomised controlled trials including 474 patients were included in the review (Table 1) [30][31][32][33][34][35][36][37][38][39][40].…”

Section: Study Selection Processmentioning

confidence: 99%

Section: Study Selection Processmentioning

confidence: 99%

Section: Impact Of Preoperative Corticosteroids On Il-6mentioning

confidence: 99%

See 2 more Smart Citations

The impact of preoperative corticosteroids on the systemic inflammatory response and postoperative complications following surgery for gastrointestinal cancer: A systematic review and meta-analysis

McSorley

Horgan

McMillan

2016

Critical Reviews in Oncology/Hematology

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“…Administration of glucocorticoids in a single preoperative dose has promising effects based on several randomised trials first of all as an anti-emetic in relatively small doses (4-8 mg dexamethasone) but also in higher doses (about 125 mg methylprednisolone) to reduce pain and facilitate early recovery [19,20]. In abdominal surgery the antiinflammatory effects of 8 mg dexamethasone is controversial [21,22] while larger doses may have both antiinflammatory and enhanced recovery effects [23,24]. Based on these initial promising results and since there may be no safety aspects [19], further procedure-specific studies on the recovery effects of perioperative glucocorticoids are required.…”

Section: Surgical Stressmentioning

confidence: 99%

Fast-track surgery—an update on physiological care principles to enhance recovery

Kehlet

2011

Langenbecks Arch Surg

156

109

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Risk Factors for Anastomotic Leak and Mortality in Diabetic Patients Undergoing Colectomy

Ziegler¹,

Catto²,

Riggs³

et al. 2012

Arch Surg

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To determine the risk factors in diabetic patients that are associated with increased postcolectomy mortality and anastomotic leak. Design: A prospectively acquired statewide database of patients who underwent colectomy was reviewed. Primary risk factors were diabetes mellitus, hyperglycemia (glucose level Ն140 mg/dL), steroid use, and emergency surgery. Categorical analysis, univariate logistic regression, and multivariate regression were used to evaluate the effects of these risk factors on outcomes. Setting: Participating hospitals within the Michigan Surgical Quality Collaborative. Patients: Database review of patients from hospitals within the Michigan Surgical Quality Collaborative. Main Outcome Measures: Anastomotic leak and 30day mortality rate. Results: Of 5123 patients, 153 (3.0%) had leaks and 153 (3.0%) died. Preoperative hyperglycemia occurred in 15.6% of patients, only 54% of whom were known to have diabetes. Multivariate analysis showed that the risk of leak for patients with and without diabetes increased only by preoperative steroid use (PϽ .05). Mortality among diabetic patients was associated with emergency surgery (P Ͻ.01) and anastomotic leak (PϽ .05); it was not associated with hyperglycemia. Mortality among nondiabetic patients was associated with hyperglycemia (P Ͻ .005). The presence of an anastomotic leak was associated with increased mortality among diabetic patients (26.3% vs 4.5%; P Ͻ .001) compared with nondiabetic patients (6.0% vs 2.5%; PϽ .05). Conclusions: The presence of diabetes did not have an effect on the presence of an anastomotic leak, but diabetic patients who had a leak had more than a 4-fold higher mortality compared with nondiabetic patients. Preoperative steroid use led to increased rates of anastomotic leak in diabetic patients. Mortality was associated with hyperglycemia for nondiabetic patients only. Improved screening may identify high-risk patients who would benefit from perioperative intervention.

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Effect of Prednisolone on Local and Systemic Response in Laparoscopic vs. Open Colon Surgery

Abstract: Preoperative administration of methylprednisolone in colon cancer patients may improve pulmonary performance and postoperative pain, and shorten length of stay regardless of the surgical technique used (laparoscopy, open colon resection).

Cited by 37 publications

References 32 publications

The impact of preoperative corticosteroids on the systemic inflammatory response and postoperative complications following surgery for gastrointestinal cancer: A systematic review and meta-analysis

The impact of preoperative corticosteroids on the systemic inflammatory response and postoperative complications following surgery for gastrointestinal cancer: A systematic review and meta-analysis

Fast-track surgery—an update on physiological care principles to enhance recovery

Risk Factors for Anastomotic Leak and Mortality in Diabetic Patients Undergoing Colectomy

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