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 McMillan, Professor Donald and Roxburgh, Professor Campbell and Dolan, Dr Ross |
| 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 > School 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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