Possible dose dependent effect of perioperative dexamethasone and laparoscopic surgery on the postoperative systemic inflammatory response and complications following surgery for colon cancer

McSorley, Stephen T.; Dolan, Ross D.; Roxburgh, Campbell S.D.; Horgan, Paul G.; MacKay, Graham J

doi:10.1016/j.ejso.2019.05.020

Cited by 14 publications

(15 citation statements)

References 24 publications

(28 reference statements)

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“…A similar finding was also observed in patients undergoing oesophagogastrectomy (OR 5·24) 33 . Conversely, two doses of perioperative dexamethasone reduced the postoperative inflammatory response and complication rate in patients undergoing colectomy for cancer 34 .…”

Section: Discussionsupporting

confidence: 74%

Physiological performance and inflammatory markers as indicators of complications after oesophageal cancer surgery

et al. 2020

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Background: The extent to which physiological factors influence outcome following oesophageal cancer surgery is poorly understood. This study aimed to evaluate the extent to which cardiorespiratory fitness and selected metabolic factors predicted complications after surgery for carcinoma. Methods: Two hundred and twenty-five consecutive patients underwent preoperative cardiopulmonary exercise testing to determine peak oxygen uptake (V O 2peak), anaerobic threshold and the ventilatory equivalent for carbon dioxide (V E/V CO 2). Cephalic venous blood was assayed for serum C-reactive protein (CRP) and albumin levels, and a full blood count was done. The primary outcome measure was the Morbidity Severity Score (MSS). Results: One hundred and ninety-eight patients had anatomical resection. A high MSS (Clavien-Dindo grade III or above) was found in 48 patients (24⋅2 per cent) and was related to an increased CRP concentration (area under the receiver operating characteristic (ROC) curve (AUC) 0⋅62, P = 0⋅001) and lowerV O 2peak (AUC 0⋅36, P = 0⋅003). Dichotomization of CRP levels (above 10 mg/l) andV O 2peak (below 18⋅6 ml per kg per min) yielded adjusted odds ratios (ORs) for a high MSS of 2⋅86 (P = 0⋅025) and 2⋅92 (P = 0⋅002) respectively. Compared with a cohort with a low Combined Inflammatory and Physiology Score (CIPS), the OR was 1⋅70 (95 per cent c.i. 0⋅85 to 3⋅39) for intermediate and 27⋅47 (3⋅12 to 241⋅69) for high CIPS (P < 0⋅001). Conclusion: CRP andV O 2peak were independently associated with major complications after potentially curative oesophagectomy for cancer. A composite risk score identified a group of patients with a high risk of developing complications.

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Section: Discussionsupporting

confidence: 74%

Physiological performance and inflammatory markers as indicators of complications after oesophageal cancer surgery

et al. 2020

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“…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%

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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“…A similar finding was also observed in patients undergoing oesophago-gastrectomy (OR 5.24) 42 . Yet these findings remain controversial, indeed McSorley et al reported that two doses of peri-operative dexamethasone, reduced the post-operative inflammatory response and complication rate in patients undergoing colectomy for cancer 43 . Therefore, it may be that patients with a CIPS>0, which accounted for 75% 0f all major morbidity in this study, will derive the most benefit from SIR attenutation.…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of compound physiology variables in oesophageal cancer

Powell

Eley

Coxon

et al. 2020

Preprint

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Aims: Objective identification of patient risk profile in Oesophageal Cancer (OC) surgery is critical. This study aimed to evaluate to what extent cardiorespiratory fitness and select metabolic factors predict clinical outcome. Methods: Consecutive 186 patients were recruited (median age 69 yr. 160 male, 138 neoadjuvant therapy). All underwent pre-operative cardiopulmonary exercise testing to determine peak oxygen uptake (V ̇O2Peak), anaerobic threshold (AT), and ventilatory equivalent for carbon dioxide (V ̇E/V ̇CO2). Cephalic venous blood was assayed for serum C-reactive protein (CRP), albumin, and full blood count. Primary outcome measures were Morbidity Severity Score (MSS), and Overall Survival (OS). Results: MSS (Clavien-Dindo >2) developed in 33 (17.7%) and was related to elevated CRP (AUC 0.69, p=0.001) and lower V ̇O2Peak (AUC 0.33, p=0.003). Dichotomisation of CRP (above 10mg/L) and V ̇O2Peak (below 18.6mL/kg/min) yielded adjusted Odds Ratios (OR) for MSS CD>2, of 4.01 (p=0.002) and 3.74 (p=0.002) respectively. OC recurrence occurred in 36 (19.4%) and 69 (37.1%) patients died. On multivariable analysis; pTNM stage (Hazard Ratio (HR) 2.20, p=0.001), poor differentiation (HR 2.20, p=0.010), resection margin positivity (HR 2.33, p=0.021), and MSS (HR 4.56, p<0.001) were associated with OS. Conclusions: CRP and V ̇O2Peak are collective independent risk factors that can account for over half of OC survival variance.

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Possible dose dependent effect of perioperative dexamethasone and laparoscopic surgery on the postoperative systemic inflammatory response and complications following surgery for colon cancer

Abstract: Possible dose dependent effect of perioperative dexamethasone and laparoscopic surgery on the postoperative systemic inflammatory response and complications following surgery for colon cancer.

Cited by 14 publications

References 24 publications

Physiological performance and inflammatory markers as indicators of complications after oesophageal cancer surgery

Physiological performance and inflammatory markers as indicators of complications after oesophageal cancer surgery

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

Prognostic significance of compound physiology variables in oesophageal cancer

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