Non-Steroidal Anti-Inflammatory Drug Use and Risk of Anastomotic Leakage after Anterior Resection: A Protocol-Based Study

Abstract

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) have been introduced as opioid-sparing analgesics in colorectal surgery. However, recent research has implicated these drugs as risk factors for anastomotic dehiscence. Methods: The Swedish Colorectal Cancer Registry was used to identify all patients operated with anterior resection for rectal cancer at centres that performed more than 25 abdominal operations per year, from 2007 to 2012, inclusive. The registry provided individual patient data on demographic variables and symptomatic anastomotic leakage. The patient exposure to NSAIDs was defined according to the protocol of the hospital at which the patient was operated. Logistic regression was employed to estimate ORs and 95% CIs, adjusting for confounders. Results: The study cohort comprised 2,605 patients operated at 21 centres. In the NSAID group, 102/1,458 (7.0%) suffered an anastomotic leak, as compared to 124/1,023 (10.8%) in the non-NSAID group. With adjustment for confounding, patients treated at NSAID hospitals had a reduced risk of developing anastomotic leakage (OR 0.68; 95% CI 0.48-0.96). Conclusions: In this retrospective protocol-based study, NSAIDs did not increase the risk of anastomotic leakage after anterior resection for rectal cancer. The postoperative use of NSAIDs may not be detrimental, but more research is warranted.

Non-steroidal anti-inflammatory drugs in the oncological surgical population: beneficial or harmful? A systematic review of the literature

“…29 In another large cohort study, patients enrolled in the Swedish Colorectal Cancer Registry were not at risk of anastomotic leak after the perioperative administration of NSAIDs for rectal cancer surgery. 28 In agreement with that investigation, Karlsson and colleagues 32 showed no association between the use of NSAIDs and anastomotic leaks after rectal cancer surgery. The impact of NSAIDs use on anastomotic leak has also been investigated in upper gastrointestinal cancers.…”

Postoperative non-steroidal anti-inflammatory drug use and oncological outcomes of rectal cancer

“…The expertise of individual surgeons and preference regarding NSAID use, which might be confounders, were not considered. However, a previous study 23 from some of the centres involved in the present analysis suggested that NSAID use is largely driven by postoperative care protocols at each hospital, not by the surgeon; thus, this potential influence is likely to be negated. Although the exposure was assessed carefully using chart review, the outcome data for recurrence were derived only from registry data.…”

Functional mucous layer and healing of proximal colonic anastomoses in an experimental model

“…Interestingly, Yauw and co-workers 40 recently showed that diclofenac, a commonly used NSAID, caused AL in the ileum and proximal colon, but not in the distal colon. Furthermore, more recently, Rutegård et al 41 found no increased risk of AL with NSAID use in patients undergoing anterior resection for rectal cancer. Previous associations between AL and NSAIDs were derived from pooled data for colorectal surgery, not solely rectal resections.…”