Association between preoperative glucocorticoids and long-term survival and cancer recurrence after colectomy: follow-up analysis of a previous randomized controlled trial

Singh, Pushpendra; Lemanu, Daniel P.; Taylor, Matthew; Hill, Andrew

doi:10.1093/bja/aet577

Cited by 53 publications

(52 citation statements)

References 41 publications

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“…However, neither the present study nor previous meta-analyses have identified a significant negative association with either wound complications or anastomotic leak14,15 Furthermore, there have been some concerns that preoperative corticosteroids may have a negative impact on oncologic outcome following surgery for colorectal cancer; however, the evidence for this is limited in both numbers and length of follow-up 22…”

Section: Discussioncontrasting

confidence: 70%

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

et al. 2017

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BackgroundThe magnitude of the postoperative systemic inflammatory response (SIR), as evidenced by C-reactive protein (CRP), is associated with both short- and long-term outcomes following surgery for colorectal cancer. The present study examined the impact of preoperative dexamethasone on the postoperative SIR and complications following elective surgery for colorectal cancer.MethodsPatients who underwent elective surgery, with curative intent, for colorectal cancer at a single center between 2008 and 2016 were included (n = 556) in this study. Data on the use of preoperative dexamethasone were obtained from anesthetic records, and its impact on CRP on postoperative days (PODs) 3 and 4, as well as postoperative complications, was assessed using propensity score matching (n = 276).ResultsIn the propensity score-matched cohort, preoperative dexamethasone was associated with fewer patients exceeding the established CRP threshold of 150 mg/L on POD 3 (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.26–0.70, p < 0.001) and fewer postoperative complications (OR 0.53, 95% CI 0.33–0.86, p = 0.009). Similar results for both POD 3 CRP and complications were observed when using propensity score-adjusted regression (OR 0.40, 95% CI 0.28–0.57 and OR 0.57, 95% CI 0.41–0.80, respectively) and propensity score stratification (OR 0.41, 95% CI 0.25–0.57 and OR 0.53, 95% CI 0.33–0.86, respectively).ConclusionsPreoperative dexamethasone was associated with a lower postoperative SIR and fewer complications following elective surgery for colorectal cancer.

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Section: Discussioncontrasting

confidence: 70%

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

et al. 2017

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“…Indeed, recent meta-analysis of both experimental and clinical trials suggests that receiving corticosteroids at standard therapeutic doses for 10 days or less is unlikely to impair wound healing [56]. Lastly, as recent preliminary reports suggest that preoperative corticosteroids may have a detrimental impact on oncologic outcome, some consideration should be given to their impact on longer term outcomes, especially in surgery for gastrointestinal cancer [57][58].…”

Section: Discussionmentioning

confidence: 99%

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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“…However, patients who had received a dose of dexamethasone (8 mg) had a significantly higher rate of distant recurrence compared with those who received placebo (six patients in the dexamethasone group vs one patient in the placebo group; P = 0.04) and a non-significant trend towards higher cancer-specific mortality. 66 …”

Section: Dexamethasonementioning

confidence: 99%

Can anesthetic-analgesic technique during primary cancer surgery affect recurrence or metastasis?

Byrne

Levins

Buggy

2015

Can J Anesth/J Can Anesth

128

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Association between preoperative glucocorticoids and long-term survival and cancer recurrence after colectomy: follow-up analysis of a previous randomized controlled trial

Abstract: Preoperative dexamethasone was associated with a higher rate of distant recurrence in patients undergoing colectomy for colon cancer. Given the small sample size, this finding should be interpreted with caution, but warrants further investigation in a prospective study.

Cited by 53 publications

References 41 publications

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

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

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

Can anesthetic-analgesic technique during primary cancer surgery affect recurrence or metastasis?

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