The Impact of Preoperative Dexamethasone on the Magnitude of the Postoperative Systemic Inflammatory Response and Complications Following Surgery for Colorectal Cancer

McSorley, Stephen T.; Roxburgh, Campbell S.D.; Horgan, Paul G.; McMillan, Donald C.

doi:10.1245/s10434-017-5817-3

Cited by 35 publications

(39 citation statements)

References 29 publications

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“…24 Furthermore, it has been observed that modulation of the postoperative systemic inflammatory response with perioperative corticosteroids is associated with fewer postoperative complications and improved survival; however, these findings are yet to be confirmed in prospective trials. 8,9 Allogeneic blood transfusion in the perioperative period is widely thought to be negatively associated with shortterm postoperative outcomes and survival in patients undergoing surgery for cancer, with an older Cochrane review, 4 a recent large propensity score matched study of over 4000 patients, 25 and a very recent comprehensive meta-analysis 3 reporting this to be the case. However, two propensity score matched cohorts from a single group of researchers found no negative impact on survival in colon 26 or rectal cancer, 27 and a smaller recent observational study found no independent impact of blood transfusion on colorectal cancer recurrence when corrected for preoperative anemia.…”

Section: Discussionmentioning

confidence: 99%

“…A proportion of patients received postoperative nausea and vomiting prophylaxis in the form of intravenous dexamethasone during surgery, at the discretion of the consultant anesthetist. 8,12 During the study period, there was no formal perioperative blood transfusion protocol. As reported previously, 13 between June 2016 and June 2017 a preoperative iron replacement protocol was in place for the relatively small number of patients found to have true iron-deficient anemia.…”

Section: Patientsmentioning

confidence: 99%

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Perioperative Blood Transfusion is Associated with Postoperative Systemic Inflammatory Response and Poorer Outcomes Following Surgery for Colorectal Cancer

et al. 2019

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Background. The present study investigated relationships between perioperative blood transfusion, postoperative systemic inflammatory response, and outcomes following surgery for colorectal cancer. Methods. Data were recorded for patients (n = 544) undergoing potentially curative, elective surgery for colorectal cancer at a single center between 2012 and 2017. Transfusion history was obtained retrospectively from electronic records. Associations between blood transfusion, postoperative C-reactive protein (CRP), albumin, hemoglobin, complications, cancer-specific survival and overall survival (OS) were assessed using propensity score matching (n =116). Results. Of 544 patients, the majority were male (n =294, 54%), over 65 years of age (n =350, 64%), and with colonic (n =347, 64%) node-negative disease (n =353, 65%). Eighty-six patients (16%) required perioperative blood transfusion. In the unmatched cohort, blood transfusion was associated with higher median postoperative day (POD) 3 CRP {143 [interquartile range (IQR) 96-221 mg/L] vs. 120 (IQR 72-188 mg/L); p = 0.004}, lower median POD 3 albumin [24 (IQR 20-26 g/L) vs. 27 (IQR 24-30 g/L); p \ 0.001], more postoperative complications [odds ratio (OR) 3.28, 95% confidence interval (CI) 2.03-5.29] and poorer OS [hazard ratio (HR) 3.18, 95% CI 2.08-4.84]. In the propensity score matched cohort, blood transfusion was similarly associated with higher median POD 3 CRP [130 (IQR 93-196 mg/L) vs. 113 (IQR 66-173 mg/L); p = 0.046], lower median POD 3 albumin [24 (IQR 20-26 g/L) vs. 26 (IQR 24-30 g/L); p \ 0.001], more postoperative complications (OR 2.91, 95% CI 1.36-6.20) and poorer OS (HR 2.38, 95% CI 0.99-5.73). Conclusions. Perioperative blood transfusion was associated with postoperative inflammation, complications, and poorer survival in patients undergoing colorectal cancer surgery, with and without propensity score techniques. A significant proportion of patients undergoing surgery for colorectal cancer require allogeneic blood transfusion in the perioperative period. 1 Such transfusions are associated with infective postoperative complications and anastomotic leak. 2,3 They are also associated with disease recurrence, 3,4 and this effect is even greater in the presence of infective complications. 5 Therefore, it has long been hypothesized that allogeneic blood transfusion might impair the host adaptive immune response to both pathogens and circulating or micrometastatic tumor cells. 6 There is increasing evidence that an exaggerated postoperative systemic inflammatory response following surgery for colorectal cancer is associated with postoperative complications and long-term survival. 7 Furthermore, there is some observational evidence that modulation of this response can improve both short-8 , and long-term outcomes. 9 It may be that perioperative blood transfusion and postoperative complications have a negative impact on oncologic outcomes via a common pathway, the systemic inflammatory response. 10

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Section: Discussionmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

Perioperative Blood Transfusion is Associated with Postoperative Systemic Inflammatory Response and Poorer Outcomes Following Surgery for Colorectal Cancer

et al. 2019

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“…Despite the widespread use of dexamethasone in the perioperative period of surgery, and numerous previously published studies, whether dexamethasone increases the risk of adverse reactions remains controversial. In this study, additional dexamethasone was given preoperatively, and no surgical site infection or gastrointestinal bleeding occurred during the observation period.…”

Section: Discussionmentioning

confidence: 89%

“…In recent 10 years, surgical techniques and perioperative management guidelines have made gratifying progress in THA, promoting the rapid recovery of patients. Tranexamic acid (TXA), a synthetic analog of lysine, inhibits fibrinolysis by competitively blocking the lysine binding site of plasminogen, often used for joint replacement to reduce perioperative blood loss, and it has anti‐inflammatory effects. Dexamethasone (DEX), with a strong anti‐inflammatory agent, has been widely used to reduce inflammatory markers, prevent PONV, and relieve postoperative pain and fatigue in various perioperative periods.…”

Section: Introductionmentioning

confidence: 99%

Combined Application of Dexamethasone and Tranexamic Acid to Reduce the Postoperative Inflammatory Response and Improve Functional Outcomes in Total Hip Arthroplasty

et al. 2020

Orthopaedic Surgery

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Objective: To evaluate the efficacy and safety of combined use of tranexamic acid (TXA) and dexamethasone (DEX) for anti-inflammatory and clinical outcomes after total hip arthroplasty (THA). Methods:A total of 100 patients were included in this randomized, controlled study. Patients in the TXA + DEX group were administered TXA at a dose of 15 mg/kg, which was repeated 3 h after THA, and received 20 mg DEX. In contrast, patients in the TXA group were administered TXA at a dose of 15 mg/kg, which was repeated at 3 h postoperatively. C-reactive protein (CRP), interleukin-6 (IL-6) and pain levels, incidence of postoperative nausea and vomiting (PONV), total blood loss and transfusion rates, postoperative fatigue, range of motion (ROM), length of hospital stay (LOS), analgesic rescue and antiemetic rescue consumption, and complications were compared in both groups. Results:The CRP and IL-6 levels were lower in the TXA + DEX group than in the TXA group (all P < 0.001) at 24 h, 48 h, and 72 h postoperatively. Patients in the TXA + DEX group had lower pain scores at rest and walking at 24 h postoperatively (all P < 0.001). In the TXA + DEX group, the incidence of PONV was lower (P = 0.005), postoperative fatigue (P < 0.001) was reduced, and analgesia and antiemetic rescue consumption were also reduced. The total blood loss, transfusion rate, LOS and hip ROM were similar in the two groups. There was no thrombosis, infection, or gastrointestinal bleeding in either group.Conclusion: Compared to TXA alone, the combination of TXA + DEX can reduce postoperative inflammatory response, relieve pain, and reduce PONV and fatigue, without increasing the risk of complications. Therefore, the present study suggested that the combination of TXA + DEX is an effective and safe accelerated rehabilitation strategy for patients receiving primary unilateral THA.

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“…The increased survival outcomes one year after surgery in the glucocorticoid group were most likely not carried by a reduction in metastatic disease since no association was found for 1-year recurrence and since 1-year DFS was increased. Part of the improved 1-year survival might be contributed to by the previously described reduced postoperative complication rates associated with perioperative glucocorticoids [41].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes after Use of Perioperative Glucocorticoids in Patients Undergoing Cancer Surgery: A Systematic Review and Meta-Analysis

Hølmich

Hasselager

Madsen

et al. 2019

Cancers

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The surgical stress response can accelerate clinical metastasis formation. Perioperative glucocorticoids might modulate this response and the metastatic process. We aimed to describe associations between perioperative glucocorticoids and long-term outcomes after cancer surgery. We searched four databases for eligible trials and performed meta-analyses on frequency and time-to-event data. We included sixteen studies that evaluated eight different cancer types. No association was found between perioperative glucocorticoids and recurrence in either the frequency meta-analysis, risk ratio (RR) 1.04, 95% confidence interval (CI) (0.87-1.25), or in the time-to-event meta-analysis, hazard ratio (HR) 1.18, 95% CI (0.78-1.79). Increased 1-year overall survival, RR 0.70, 95% (0.51-0.97), and disease-free survival, RR 0.77, 95% CI (0.60-0.97), was found for the glucocorticoid group, but five years after surgery, overall survival was reduced for the glucocorticoid group, RR 1.64, 95% CI (1.00-2.71). An exploratory subgroup analysis revealed decreased overall survival, HR 1.78, 95% CI (1.57-2.03), for patients undergoing colorectal cancer surgery while receiving glucocorticoids. Perioperative glucocorticoids were not associated with recurrence after cancer surgery. We found neither beneficial or deleterious associations between glucocorticoids and overall survival or disease-free survival. The available evidence remains heterogenous; low in quality and amount; and cancer-specific at present.Cancers 2020, 12, 76 2 of 22 such as glucocorticoids. Preliminary animal studies have investigated the effect of steroids on cancer progression and the results are not conclusive [6,7]. Some suggest that endogenous glucocorticoids released from prolonged stress response may hinder natural killer (NK) cell activity, which is essential in malignant defence, but the effect might not be as significant as the NK cell suppression mediated by stress related catecholamines [8]. On the other hand, the anti-inflammatory effects of glucocorticoids might prove beneficial in breaking the inflammatory cycle.Glucocorticoids are known to modulate the inflammatory stress response and are increasingly used in the perioperative period. Administration of low-dose perioperative dexamethasone is used for prevention of postoperative nausea and vomiting (PONV). Use of high dose glucocorticoids has been shown to have analgesic effects and may even decrease the risk of postoperative complications [9] without increasing short-term adverse events [10]. It appears that glucocorticoids are safe and beneficial for immediate postoperative outcomes. However, evaluation of safety and possible benefits on long-term oncologic outcomes remain to be shown. Furthermore, it has been recommended that the effect of adjunct medications for anaesthesia on oncological outcomes should be prioritized by researchers [11].In this study, we hypothesized that the use of perioperative glucocorticoids may impact long-term survival after cancer surgery. We aimed to describe the possible assoc...

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The Impact of Preoperative Dexamethasone on the Magnitude of the Postoperative Systemic Inflammatory Response and Complications Following Surgery for Colorectal Cancer

Cited by 35 publications

References 29 publications

Perioperative Blood Transfusion is Associated with Postoperative Systemic Inflammatory Response and Poorer Outcomes Following Surgery for Colorectal Cancer

Perioperative Blood Transfusion is Associated with Postoperative Systemic Inflammatory Response and Poorer Outcomes Following Surgery for Colorectal Cancer

Combined Application of Dexamethasone and Tranexamic Acid to Reduce the Postoperative Inflammatory Response and Improve Functional Outcomes in Total Hip Arthroplasty

Long-Term Outcomes after Use of Perioperative Glucocorticoids in Patients Undergoing Cancer Surgery: A Systematic Review and Meta-Analysis

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