Attitudes towards the use of perioperative steroids in resectional colorectal cancer surgery in the UK: a qualitative study

Golder, A. M. , McSorley, S. T. , Kearns, R. J. , McMillan, D. C. , Horgan, P. G. and Roxburgh, C. S. (2019) Attitudes towards the use of perioperative steroids in resectional colorectal cancer surgery in the UK: a qualitative study. Annals of Medicine and Surgery, 48, pp. 23-28. (doi: 10.1016/j.amsu.2019.10.007) (PMID:31687135) (PMCID:PMC6820077)

Abstract

Introduction: Resectional surgery remains the mainstay of treatment for colorectal cancer. A heightened postoperative systemic inflammatory response has been shown to correlate negatively with short/long-term outcomes. Perioperative steroid administration may help to alleviate this systemic inflammatory response. This survey has been carried out to assess current attitudes towards perioperative steroid use and to gauge interest in a randomised control trial in this area. Method: An internet-based survey consisting of 9 questions was circulated via email. Those responses from outside the United Kingdom were excluded. Result: 74 doctors from the United Kingdom, predominantly Consultant Anaesthetists (54%) responded to this survey. 77% gave some or all of their patients steroids, in 75% of cases at the discretion of the anaesthetist. The main perceived benefit was to reduce postoperative nausea and vomiting. Diabetics and those deemed at high risk of wound infection were the group in whom most respondents would be reluctant to give steroids. 32% of respondents had no concerns. 87% of respondents felt that that a randomised trial in this field would be of clinical interest with most respondents (58%) preferring a three-armed trial – no steroids vs low dose steroids vs high dose steroids. Conclusion: – This survey indicated that perioperative steroid use is currently widespread. Sufficient equipoise exists for a trial in this area with regard to examining the impact of dexamethasone on postoperative complications and the postoperative systemic inflammatory response. Respondents favoured a 3-armed trial – no steroids vs low-dose steroids vs high-dose steroids.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Horgan, Professor Paul and Golder, Mr Allan and McMillan, Professor Donald and McSorley, Dr Stephen and Kearns, Dr Rachel and Roxburgh, Professor Campbell
• Authors: Golder, A. M., McSorley, S. T., Kearns, R. J., McMillan, D. C., Horgan, P. G., and Roxburgh, C. S.
• 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: Annals of Medicine and Surgery
• Publisher: Elsevier
• ISSN: 2049-0801
• Published Online: 11 October 2019
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in Annals of Medicine and Surgery 48:23-28
• Publisher Policy: Reproduced under a Creative Commons License