Perioperative Management May Improve Long-term Survival in Patients After Lung Cancer Surgery: A Retrospective Cohort Study

Huang, Wenwen; Zhu, Wenzhi; Mu, Dong-Liang; Ji, Xinqiang; Nie, Xiaolu; Li, Xueying; Wang, Dong‐Xin; Ma, Ding

doi:10.1213/ane.0000000000002886

Cited by 29 publications

(43 citation statements)

References 41 publications

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“…The included studies reported on a variety of eight cancer types: pancreatic adenocarcinoma [19,28], non-small-cell lung cancer [20,23,34], ovarian [21], rectal [22,33], colorectal [25,31], endometrial [26], oesophageal [27,29,30,32], and breast cancer [24]. Sample sizes range from 37 [27] to 2628 [24] patients and the follow-up periods from six months to ten years.…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

“…One of these was analysed as two separate studies, and will be referred to as two studies, because the participants were divided into two study populations according to lymph node dissemination [25]. Fifteen studies reported OS [19,20,[22][23][24][25][26][27][28][29][30][31][32][33] and seven studies reported DFS [20,23,26,[31][32][33][34]. Several studies reported recurrence-free survival or progression-free survival; however, this definition was in accordance with our predetermined definition of DFS and was analysed as such.…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

“…Four of the included studies were randomised controlled trials [22,29,31,32] (one of these was the study not included in the meta-analysis [22]) and the remaining twelve were retrospective cohort studies. Eleven studies found no association between the use of perioperative glucocorticoids and any of our outcomes [21,22,[24][25][26][27][29][30][31][32]; four studies found associations in favour of glucocorticoids [19,23,28,34]; and two studies found associations in favour of the control group [20,33] (see Supplementary Material, Table S4 for all study results).…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

“…Of the five studies eligible for the recurrence analyses, three had a low risk of bias [21,24,26]; two a medium risk of bias [25]; and one study was a randomised trial with almost entirely unclear risk of bias [32]. In the OS analyses, six non-randomised studies had a low risk of bias [19,20,23,24,26,33], and five had a medium risk [25,27,28,30]. Of the eligible randomised trials, one had an unclear risk of bias [32] and two had a low risk [29,31].…”

Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

“…Of the eligible randomised trials, one had an unclear risk of bias [32] and two had a low risk [29,31]. The DFS analyses included non-randomised studies with only low risks of bias [20,23,26,33,34]; one randomised study with an unclear risk of bias [32] and one with a low risk [31] (see Table 3 for risk of bias analyses). Each non-randomised study was judged according to a 'star-system' in which a number of stars (*) was awarded in line with predefined criteria by the Newcastle-Ottawa Scale.…”

Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

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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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Section: Study and Patient Characteristicsmentioning

confidence: 99%

Section: Study and Patient Characteristicsmentioning

confidence: 99%

Section: Study and Patient Characteristicsmentioning

confidence: 99%

Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

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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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Neoplastic Disease

Salazar

2021

Canine and Feline Anesthesia and Co‐Existing Disease

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Effects of Oxycodone Combined With Flurbiprofen Axetil on Postoperative Analgesia and Immune Function in Patients Undergoing Radical Resection of Colorectal Cancer

Wan

Chu

Zhou

et al. 2020

Clinical Pharm in Drug Dev

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The influence of surgery and anesthesia on immune function during the perioperative period should not be neglected. In this study, we evaluated the effects of oxycodone combined with flurbiprofen axetil on postoperative analgesia and immune function in patients undergoing radical resection of colorectal cancer (CRC). One hundred and thirty‐three were randomized into the oxycodone combined with flurbiprofen axetil (OF) group or the sufentanil combined with flurbiprofen axetil (SF) group. Patients in the OF group were prescribed oxycodone hydrochloride 0.1 mg/kg combined with flurbiprofen axetil 3 mg/kg for postoperative analgesia, whereas the SF group received sufentanil 0.1 μg/kg combined with flurbiprofen axetil 3 mg/kg. The primary outcome was visual analog scale (VAS) score. Secondary outcomes included the quantities of CD4+, CD8+, and natural killer (NK) T cells, tumor necrosis factor (TNF)‐α level, and interleukin (IL)‐6 in peripheral blood, the consumption of analgesics, and the incidence of adverse reactions, and so forth. The VAS scores at rest were similar in both group. However, the VAS scores at cough in the OF group at 8, 12, and 24 hours postsurgery were lower than those in the SF group. Compared with the SF group, the count of CD4+ T cells and ratio of CD4+/CD8+ were higher in the OF group at 12, 24, 48, and 72 hours postsurgery, although the count of CD8+ and NK T cells was higher than that in the SF group at 48 and 72 hours postsurgery. In addition, the serum level of TNF‐α and IL‐6 at 12, 24, 48, and 72 hours postsurgery in the OF group was lower than that in the SF group. In addition, the incidence of postoperative nausea, postoperative vomiting, and pruritus was lower, the time to first flatus and bowel movement was earlier in the OF group. Oxycodone combined with flurbiprofen axetil applied for patient‐controlled intravenous analgesia could effectively reduce pain intensity, particularly for visceral pain, and help to reverse the status of immunosuppression during radical resection of CRC.

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Perioperative Management May Improve Long-term Survival in Patients After Lung Cancer Surgery: A Retrospective Cohort Study

Cited by 29 publications

References 41 publications

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

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

Neoplastic Disease

Effects of Oxycodone Combined With Flurbiprofen Axetil on Postoperative Analgesia and Immune Function in Patients Undergoing Radical Resection of Colorectal Cancer

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