Impact of celecoxib on inflammation during cancer surgery: a randomized clinical trial

Hiller, Jonathan G.; Sampurno, Shienny; Millen, Rosemary; Kuruvilla, Niketh; Ho, Kwok M.; Ramsay, Robert G.; Riedel, Bernhard

doi:10.1007/s12630-017-0818-z

Cited by 11 publications

(8 citation statements)

References 36 publications

(49 reference statements)

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“…81 The anti-inflammatory effects of NSAIDs are well known, with studies confirming reduced circulating inflammatory mediators associated with administration of traditional NSAIDs and COX-2 inhibitors perioperatively. 82,83 Furthermore, concerns exist regarding the immunosuppressive properties of opioids, 84 thereby potentially affecting cancer recurrence. The opioid-sparing properties of NSAIDs may be utilised to minimise these immunosuppressive effects.…”

Section: Discussionmentioning

confidence: 99%

Nonsteroidal anti-inflammatory drugs and pain in cancer patients: a systematic review and reappraisal of the evidence

Magee

Jhanji

Poulogiannis

et al. 2019

British Journal of Anaesthesia

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Background: Emerging data highlights the potential role of cyclooxygenase (COX) inhibitors in the primary prevention of malignancy, reducing metastatic spread and improving overall mortality. Despite nonsteroidal anti-inflammatory drugs (NSAIDs) forming a key component of the WHO analgesic ladder, their use in cancer pain management remains relatively low. This review re-appraises the current evidence regarding the efficacy of COX inhibitors as analgesics in cancer pain, providing a succinct resource to aid clinicians' decision making when determining treatment strategies. Methods: Medline® and Embase® databases were searched for publications up to November 2018. Randomised controlled trials (RCTs) and double-blind controlled studies considering the use of NSAIDs for management of cancerrelated pain in adults were included. Animal studies, case reports, and retrospective observational data were excluded. Results: Thirty studies investigating the use of NSAIDs in cancer pain management were identified. There is a lack of high-quality evidence regarding the analgesic efficacy of NSAIDs in cancer pain, with short study durations and heterogeneity in outcome measures limiting the ability to draw meaningful conclusions. Conclusions: Despite the renewed interest in these cost-effective, well-established medications in cancer treatment outcomes, there is a paucity of data from the past 15 yr regarding their efficacy in cancer pain management. However, when analgesic strategies in the cancer population are being formulated, it is important that the potential benefits of this class of drug are considered. Further work investigating the role of NSAIDs in cancer pain management is undoubtedly warranted.

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Section: Discussionmentioning

confidence: 99%

Nonsteroidal anti-inflammatory drugs and pain in cancer patients: a systematic review and reappraisal of the evidence

Magee

Jhanji

Poulogiannis

et al. 2019

British Journal of Anaesthesia

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“…A study of perioperatively delivered COX2 inhibitors revealed a reduction in prostaglandin levels at the surgical site and in the systemic circulation. Similarly COX2 inhibitors have been shown to suppress increases in systemic catecholamine, cytokine and T-cell levels, and to also buffer the reduction in NK cell counts in the postoperative period ( 111 – 115 ). Data from these prospective clinical studies (2014–2017) suggest an indirect anticancer effect.…”

Section: Non-steroidal Inflammatory Drugs (Nsaids)mentioning

confidence: 99%

Can Acute Postoperative Pain Management After Tumour Resection Surgery Modulate Risk of Later Recurrence or Metastasis?

2021

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BackgroundCancer is a leading cause of mortality worldwide, but death is rarely from the primary tumour: Rather it is multi-organ dysfunction from metastatic disease that is responsible for up to 90% of cancer-related deaths. Surgical resection of the primary tumour is indicated in 70% of cases. The perioperative stress response, tissue hypoxia at the site of surgery, and acute pain contribute to immunosuppression and neo-angiogenesis, potentially promoting tumour survival, proliferation, and metastasis. Poorly controlled acute postoperative pain decreases Natural Killer (NK) immune cell activity, which could potentially facilitate circulating tumour cells from evading immune detection. This consequently promotes tumour growth and distal metastasis.MethodsWe conducted a comprehensive literature search for links between acute pain and cancer outcomes using multiple online databases. Relevant articles from January 1st, 2010 to September 1st, 2021 were analysed and appraised on whether postoperative pain control can modulate the risk of recurrence, metastasis, and overall cancer survival.ResultsAlthough experimental and retrospective clinical data suggest a plausible role for regional anaesthesia in cancer outcome modulation, this has not been supported by the single, largest prospective trial to date concerning breast cancer. While there are mixed results on anaesthesiology drug-related interventions, the most plausible data relates to total intravenous anaesthesia with propofol, and to systemic administration of lidocaine.ConclusionThe hypothesis that anaesthetic and analgesic technique during cancer surgery could influence risk of subsequent recurrence or metastasis has been prevalent for >15 years. The first, large-scale definitive trial among women with breast cancer found robust equivalent findings between volatile anaesthesia with opioid analgesia and regional anaesthesia. Therefore, while regional anaesthesia during tumour resection does not seem to have any effect on cancer outcomes, it remains plausible that other anaesthetic techniques (e.g. total intravenous anaesthesia and systemic lidocaine infusion) might influence oncologic outcome in other major tumour resection surgery (e.g. colorectal and lung). Therefore, another large trial is needed to definitively answer these specific research questions. Until such evidence is available, perioperative analgesia for cancer surgery of curative intent should be based on patient co-morbidity and non-cancer endpoints, such as optimising analgesia and minimising postoperative complications.

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“…A recent RCT has demonstrated that the administration of flurbiprofen to women undergoing breast cancer surgery not only decreases opioid consumption but also reduces the circulating concentrations of tumour necrosis factor-a, interleukin-b and vascular endothelial growth factor. 81 Hiller and colleagues 82 have shown that the perioperative administration of celecoxib 400 mg preoperative followed by 200 mg twice daily for 5 days postoperatively slightly decreases the plasma concentration of PGE2 after major intracavity cancer surgery.…”

Section: Perioperative Nsaids and Cancer Recurrencementioning

confidence: 99%

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

Cata

Guerra

Chang

et al. 2017

British Journal of Anaesthesia

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The literature is not conclusive on whether the use of NSAIDs is associated with anastomotic leaks after gastrointestinal cancer surgery. Also, the current evidence is equivocal regarding the effects of short-term NSAIDs on cancer recurrence after major cancer surgery. Three RCTs are being conducted to assess the impact of NSAIDs on cancer recurrence. There are no registered RCTs that are testing the hypothesis of whether the perioperative use of NSAIDs increases the rate of anastomotic leaks.

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Impact of celecoxib on inflammation during cancer surgery: a randomized clinical trial

Cited by 11 publications

References 36 publications

Nonsteroidal anti-inflammatory drugs and pain in cancer patients: a systematic review and reappraisal of the evidence

Nonsteroidal anti-inflammatory drugs and pain in cancer patients: a systematic review and reappraisal of the evidence

Can Acute Postoperative Pain Management After Tumour Resection Surgery Modulate Risk of Later Recurrence or Metastasis?

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

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