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

Abstract

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.

Perioperative biobehavioral interventions to prevent cancer recurrence through combined inhibition of β‐adrenergic and cyclooxygenase 2 signaling

“…15,16,31,34,43 Of much recent interest are the use of neuro-axial techniques or regional block, 16,31,44,45 the use of deoxyribonuclease to inhibit the formation of neutrophil extracellular traps, 46 and the perioperative blockade of inflammatory and sympathetic responses, 12,16,43,47 which are detailed later. 15,16,31,34,43 Of much recent interest are the use of neuro-axial techniques or regional block, 16,31,44,45 the use of deoxyribonuclease to inhibit the formation of neutrophil extracellular traps, 46 and the perioperative blockade of inflammatory and sympathetic responses, 12,16,43,47 which are detailed later.…”

“…12,16,17,43 Adrenergic signaling increases the numbers of monocytes in the circulation 54 and stimulates tumor cells to secrete chemokines (eg, colony stimulating factor 1 [CSF1] and C-C motif chemokine ligand 2 [CCL2]), which attract monocytes to infiltrate the tumor and evolve into macrophages. 12,16,17,43 Adrenergic signaling increases the numbers of monocytes in the circulation 54 and stimulates tumor cells to secrete chemokines (eg, colony stimulating factor 1 [CSF1] and C-C motif chemokine ligand 2 [CCL2]), which attract monocytes to infiltrate the tumor and evolve into macrophages.…”

“…12 These studies have shown decreased metastatic loads and increased survival rates in response to perioperative SIR Cancer January 1, 2019 inhibition in many tumor models. Perioperative COX inhibition also has provided inconclusive results, as recently reviewed by Cata et al 43 Notably, aspirin, a nonselective COX inhibitor, was recently recommended for the prevention of colorectal cancer (CRC) in men at risk between the ages of 50 and 59 years. 12,22,33,66,67,84,89 Retrospective clinical studies have provided inconclusive results regarding incidental perioperative or chronic use of β-blockers, with several studies, [90][91][92] but not others, 93,94 reporting beneficial effects on long-term cancer outcomes, especially with respect to nonselective β-blockade.…”

“…16,43 Specifically, 2 RCTs using celecoxib (a selective COX2 inhibitor; n = 32) 102 and low-dose aspirin (n = 40), 95 respectively, showed a slight reduction of systemic inflammatory markers (PG metabolites in urine) during cancer surgery and reduced PGE2 levels in the rectal mucosa of patients undergoing CRC screening. 16,43 Specifically, 2 RCTs using celecoxib (a selective COX2 inhibitor; n = 32) 102 and low-dose aspirin (n = 40), 95 respectively, showed a slight reduction of systemic inflammatory markers (PG metabolites in urine) during cancer surgery and reduced PGE2 levels in the rectal mucosa of patients undergoing CRC screening.…”

“…Researchers and clinicians are currently studying such perioperative processes and medical routines with the aim of preserving the beneficial effects of surgery while diminishing its deleterious, prometastatic effects. 15,16,31,34,43 Of much recent interest are the use of neuro-axial techniques or regional block, 16,31,44,45 the use of deoxyribonuclease to inhibit the formation of neutrophil extracellular traps, 46 and the perioperative blockade of inflammatory and sympathetic responses, 12,16,43,47 which are detailed later. These endeavors, if successful, may have a profound impact on the course and outcomes of disease.…”