Pre-operative beta-blocker therapy does not affect short-term mortality after esophageal resection for cancer

Abstract

Background It has been postulated that the hyperadrenergic state caused by surgical trauma is associated with worse outcomes and that β-blockade may improve overall outcome by downregulation of adrenergic activity. Esophageal resection is a surgical procedure with substantial risk for postoperative mortality. There is insufficient data to extrapolate the existing association between preoperative β-blockade and postoperative mortality to esophageal cancer surgery. This study assessed whether preoperative β-blocker therapy affects short-term postoperative mortality for patients undergoing esophageal cancer surgery. Methods All patients with an esophageal cancer diagnosis that underwent surgical resection with curative intent from 2007 to 2017 were retrospectively identified from the Swedish National Register for Esophagus and Gastric Cancers (NREV). Patients were subdivided into β-blocker exposed and unexposed groups. Propensity score matching was carried out in a 1:1 ratio. The outcome of interest was 90-day postoperative mortality. Results A total of 1466 patients met inclusion criteria, of whom 35% (n = 513) were on regular preoperative β-blocker therapy. Patients on β-blockers were significantly older, more comorbid and less fit for surgery based on their ASA score. After propensity score matching, 513 matched pairs were available for analysis. No difference in 90-day mortality was detected between β-blocker exposed and unexposed patients (6.0% vs. 6.6%, p = 0.798). Conclusion Preoperative β-blocker therapy is not associated with better short-term survival in patients subjected to curative esophageal tumor resection.

Nerves in gastrointestinal cancer: from mechanism to modulations

“…Targeting sympathetic signals Blocking sympathetic β-adrenergic receptors has shown promise in lowering the recurrence and long-term mortality of several (gastrointestinal) cancer types 261,262 , but failed to reduce short-term mortality in patients with oesophageal cancer 263,264 . Moreover, a meta-analysis of the observational studies in CRC have shown no improvement in overall survival (HR 0.90, 95% CI 0.93-1.10) 265 .…”