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

McSorley, S. T. , Dolan, R. D. , Roxburgh, C. S.D. , Horgan, P. G. , MacKay, G. J. and McMillan, D. C. (2019) Possible dose dependent effect of perioperative dexamethasone and laparoscopic surgery on the postoperative systemic inflammatory response and complications following surgery for colon cancer. European Journal of Surgical Oncology, 45(9), pp. 1613-1618. (doi: 10.1016/j.ejso.2019.05.020) (PMID:31130339)

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Abstract

Background: Perioperative dexamethasone is associated with attenuation of the postoperative systemic inflammatory response and fewer postoperative complications following elective surgery for colorectal cancer. This study examined the impact of different doses of dexamethasone, given to reduce postoperative nausea and vomiting (PONV) after elective colonic resection for cancer, on the postoperative Glasgow Prognostic Score (poGPS) and morbidity. Methods: Patients from a single centre were included if they underwent potentially curative resection of colonic cancer from 2008 to 2017 (n = 480). Patients received no dexamethasone (209, 44%), or either 4 mg (166, 35%), or 8 mg (105, 21%), intravenously during anaesthesia, at the discretion of the anaesthetist. The postoperative Glasgow Prognostic Score (poGPS) on day 3 and 4, and complication rate at discharge were recorded. Results: When patients were grouped by surgical approach (open or laparoscopic) and dexamethasone dose (0 mg, 4 mg or 8 mg), there was a statistically significant linear trend toward a lower postoperative systemic inflammatory response (day 3 poGPS) with the use of minimally invasive surgery and higher doses of dexamethasone (p < 0.001). Furthermore, this combination of laparoscopic surgery and higher doses of dexamethasone was significantly associated with a lower proportion of postoperative complications (p < 0.001). At multivariate Cox regression, dexamethasone was not significantly associated with either improved or poorer cancer specific or overall survival. Conclusions: Higher doses of perioperative dexamethasone are associated with greater reduction in postoperative systemic inflammation and complications following surgery for colonic cancer without negative impact on survival.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Horgan, Professor Paul and Mackay, Mr Graham and McSorley, Dr Stephen and Roxburgh, Dr Campbell and Dolan, Dr Ross and McMillan, Professor Donald
Authors: McSorley, S. T., Dolan, R. D., Roxburgh, C. S.D., Horgan, P. G., MacKay, G. J., and McMillan, D. C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cancer Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:European Journal of Surgical Oncology
Publisher:Elsevier
ISSN:0748-7983
ISSN (Online):1532-2157
Published Online:20 May 2019
Copyright Holders:Copyright © 2019 Elsevier Ltd.
First Published:First published in European Journal of Surgical Oncology 45(9):1613-1618
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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