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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-analy...
Contexts in source publication
Context 1
... search did not contain any filters, language-or time restraints. The search string was peer-reviewed by two information specialists from separate reference libraries not otherwise affiliated with the project (see Table S1 for search string). ...Context 2
... following variables for eligible studies were extracted if reported: type of study; study design; trial size; type of cancer; Union for International Cancer Control (UICC) stage; type of surgery; type, dose and frequency of glucocorticoid administered; time to follow-up; reasons for loss of follow-up; causes of death; cancer recurrence; death; and time to event data (HR) (see Table 1 for study characteristics and Table 2 for patient characteristics). ...Context 3
... Materials: The following are available online at http://www.mdpi.com/2072-6694/12/1/76/s1, Figure S1: Forest plot of the unadjusted hazard-ratios for overall survival after cancer surgery according to cancer type, applying a random effect model on time-to-event data, Figure S2: Forest plot of the unadjusted hazard-ratios for overall survival after cancer surgery according to dexamethasone dose (20 mg as cut-off), applying a random effect model on time-to-event data, Figure S3: Forest plot of the adjusted hazard-ratios for overall survival after cancer surgery, applying a random effect model on time-to-event data (sensitivity analysis), Table S1: PubMed search string for systematic review about perioperative glucocorticoid treatment for cancer surgery and long-term outcomes, date of search: 27 March 2019, Table S2: List of relevant foreign articles that could not be translated for eligibility evaluation for systematic review about perioperative glucocorticoid treatment for cancer surgery and long-term outcomes, Table S3: List of contact attempts for systematic review about perioperative glucocorticoid treatment for cancer surgery and long-term outcomes, Table S4: Results of individual studies included in systematic review about perioperative glucocorticoid treatment for cancer surgery and long-term outcomes for (a) recurrence, (b) unadjusted overall survival, (c) adjusted overall survival (d) disease-free survival and (e) cancer-specific survival. Project administration, E.R.H.; Supervision, I.G., R.P.H., M.T.M.; Visualization, E.R.H.; Writing-Original Draft Preparation, E.R.H.; Writing-Review & Editing, all authors. ...Similar publications
Introduction:
Development of immune-related adverse events (irAEs) has been associated with enhanced efficacy with the use of immune checkpoint inhibitors (ICIs). It remains unknown whether such an association exists in advanced hepatocellular carcinoma (aHCC). This study aims to evaluate the association between irAEs and ICI efficacy in patients...
Citations
... Incidence of PONV varies significantly with procedure type and duration of anesthesia, and thus, studying a more homogenous cohort, such as was performed in the present review, may be advantageous moving forward. [64] While the present review focused on short-term postoperative outcomes, some concern has arisen recently with regard to the safety of perioperative glucocorticoids from an oncologic perspective due to their immune and inflammatory cascade-modulating effects [65]. This has been heightened by the increasing use of immunotherapy for adjuvant [66]. ...
Purpose
Dexamethasone is a glucocorticoid that is often administered intraoperatively as prophylaxis for postoperative nausea and vomiting (PONV). Several randomized controlled trials (RCTs) have examined its use in colorectal surgery. This systematic review aims to assess the postoperative impacts of dexamethasone use in colorectal surgery.
Methods
MEDLINE, Embase, and CENTRAL were searched from database inception to January 2023. Articles were included if they compared perioperative intravenous dexamethasone to a control group in patients undergoing elective colorectal surgery in terms of postoperative morbidity. The primary outcomes were prolonged postoperative ileus (PPOI) and PONV. Secondary outcomes included postoperative infectious morbidity and return of bowel function. A pair-wise meta-analysis and GRADE assessment of the quality of evidence were performed.
Results
After reviewing 3476 relevant citations, seven articles (five RCTs, two retrospective cohorts) met the inclusion criteria. Overall, 1568 patients received perioperative dexamethasone and 1459 patients received a control. Patients receiving perioperative dexamethasone experienced significantly less PPOI based on moderate-quality evidence (three studies, OR 0.46, 95%CI 0.28–0.74, p < 0.01). Time to first flatus was significantly reduced with intravenous dexamethasone. There was no difference between groups in terms of PONV (four studies, OR 0.90, 95%CI 0.64–1.27, p = 0.55), postoperative morbidity (OR 0.93, 95%CI 0.63–1.39, p = 0.74), or rate of postoperative infectious complications (seven studies, OR 0.74, 95%CI 0.55–1.01, p = 0.06).
Conclusion
This review presents moderate-quality evidence that perioperative intravenous dexamethasone may reduce PPOI and enhance the return of bowel function following elective colorectal surgery. There was no significant observed effect on PONV or postoperative infectious complications.
... Загальновизнано, що надмірне запалення є згубним для післяопераційного відновлення, отже, використання періопераційної терапії кортикостероїдами для пригнічення медіаторів запалення рекомендується як підхід до покращення прогнозу [8]. Однак, як повідомляє ряд авторів [1,2,4], клінічні переваги та ризики, пов'язані з періопераційною терапією стероїдами залишаються незрозумілими через суперечливий характер результатів та відсутність ретельного дослідження. ...
... Тоді як післяопераційні показники експресії моноцитами IL-6 в крові у пацієнтів, яким вводили метилпреднізолон були достовірно нижчими на 1-у та 3-ю післяопераційну добу (табл. [4,5], які показали, що періопераційне введення метилпреднізолону стримує прозапальні цитокіни на помірному рівні та покращує післяопераційний стан хворих. Також треба відмітити, що на 5-у післяопераційну добу рівні експресії моноцитами IL-6 у крові не відрізнялись (p=0,61): 0,010±0,006 у досліджуваній групі та 0,015±0,008 у контрольній групі. ...
Annotation. One lung ventilation (OLV) is one of the most difficult intraoperative methods of respiratory support for anesthesiologists. OLV should provide the most comfortable surgical field, maintaining proper gas exchange and minimizing damage to both lungs. This anesthetic procedure has a significant inflammatory response, so using perioperative corticosteroid therapy to suppress inflammatory mediators is recommended as an approach to improving prognosis. Therefore, the aim of this study was to determine how the preoperative administration of methylprednisolone affects the systemic proinflammatory response of cytokines during thoracic surgery. The analysis was performed for 80 patients who underwent surgeries in the thoraco-abdominal department of the Shalimov National Institute of Surgery and Transplantology. Patients were divided into 2 groups (study – 40 patients who were administered methylprednisolone 10 mg / kg intravenously during induction of anesthesia and control – 40 patients without methylprednisolone). Before surgery and in the postoperative period on days 1, 3 and 5, the surface phenotype of peripheral blood lymphocytes and the expression of IL-6 by monocytes were determined by flow cytofluorometry. The author's MedStat package was used for statistical analysis (Lyakh Yu.E., Guryanov V.G., 2004–2012). Postoperative indicators of IL-6 monocyte expression in the blood of patients administered methylprednisolone were significantly lower on the 1st and 3rd postoperative day (p<0.001). Thus, preoperative administration of methylprednisolone reduces the release of pro-inflammatory cytokines and improves the condition of patients after thoracic surgery. We consider it expedient to conduct further research on the administration of methylprednisolone for several days in the postoperative period.
... Postoperative NSAIDs following colorectal surgery showed improved pain score, opioid sparing effect, and enhanced early recovery of bowel function, but NSAIDs increased anastomotic leak by inhibiting the normal wound healing process and interfering with angiogenesis [31]. Perioperative glucocorticoid following cancer surgery produces analgesic effects at a high dose, but high and repetitive doses might have immunosuppressive effects [32]. NMDA antagonists are pharmacological agents used in central sensitization and neuropathic pain [33]. ...
Despite rapid advancements in laparoscopic surgical techniques and perioperative management, postoperative pain remains a significant clinical issue. We examined the analgesic efficacy of nefopam as an adjuvant in patient-controlled analgesia (PCA) for acute postoperative pain in patients undergoing laparoscopic colorectal cancer surgery. We retrospectively analyzed the medical records of 120 patients who did or did not receive 80 mg of nefopam as an adjuvant in fentanyl PCA; they were allocated to the nefopam (n = 60) or non-nefopam group (n = 60). The demographic, clinical, and anesthetic data, with data on pain severity and opioid administration at the postoperative anesthesia care unit (PACU) on postoperative days (PODs) 1, 3, and 5, were compared between the groups. The pain score and opioid administration did not differ at the PACU or on PODs 1, 3, or 5. The day of PCA discontinuation, time to pass flatus, length of the hospital stay, and incidence of nausea/vomiting, dizziness, and headache also did not differ between the groups. Fentanyl PCA with 80 mg of nefopam as an adjuvant did not have a superior analgesic effect after laparoscopic colorectal cancer surgery.
Background:
Total joint arthroplasties (TJAs) of the hip and knee are common orthopaedic procedures. Postoperative pain in TJA is managed with opioids, which carry notable adverse effects and are associated with high dependency rates. With newer multimodal pain control regimens, perioperative glucocorticoid administration has shown promise as a means of mitigating postoperative pain. The objective of this review was to identify the effects of perioperative intravenous glucocorticoid administration on postoperative outcomes in TJA.
Materials and methods:
A systematic review was done. The EMBASE database was searched from inception through September 1, 2020, to identify studies of perioperative glucocorticoids in TJA. Primary outcomes were postoperative pain, nausea, and vomiting. Secondary outcomes included hospital length of stay, postoperative opioid utilization, antiemetic rescue medication use, and postoperative surgical complications.
Results:
Our search yielded 429 publications; 14 studies were ultimately included, incorporating 1704 patients. In 13 of 14 studies, pain scores improved with perioperative steroid administration. Regarding postoperative nausea and vomiting, most of the studies found a notable association between steroids and improved VAS-N (visual analogue scale for nausea) and decreased postoperative nausea and vomiting incidence. There were inconclusive data on the effects of perioperative steroids regarding postoperative length of stay, fatigue, and range of motion of the affected joint. In all 14 studies, no notable difference was found between study groups regarding postoperative surgical complications.
Conclusion:
This systematic review supports the use of perioperative steroids in TJA for mitigating postoperative pain, nausea, and systemic inflammation. Additional randomized trials are needed to form a consensus on optimal dosing, delivery method, and timing of perioperative glucocorticoids in TJA.
Background:
Inflammation control is a fundamental part of chronic care in patients with a history of cancer and comorbidity. As the risk-benefit profile of anti-inflammatory drugs in cancer survivors (CS) is unclear, GPs and patients could benefit from alternative non-pharmacological treatment options for dysregulated inflammation. There is a potential for home built environment (H-BE) interventions to modulate inflammation, however, discrepancies exist between studies.
Aim:
To evaluate the effectiveness of H-BE interventions on cancer-associated inflammation biomarkers.
Design & setting:
A systematic review and meta-analysis of randomised and non-randomised trials in community-dwelling adults.
Method:
PubMed-Medline, Embase, Web of Science, and Google Scholar will be searched for clinical trials published in January 2000 onwards. We will include H-BE interventions modifying air quality, thermal comfort, non-ionising radiation, noise, nature and water. No restrictions to study population will be applied to allow deriving expectations for effects of the interventions in CS from available source populations. Outcome measures will be inflammatory biomarkers clinically and physiologically relevant to cancer. The first reviewer will independently screen articles together with GPs and extract data that will be verified by a second reviewer. The quality of studies will be assessed using the Cochrane Risk-of-Bias tools. Depending on the clinical and methodological homogeneity of populations, interventions, and outcomes, we will conduct a meta-analysis using random-effects models.
Conclusions:
Findings will determine the effectiveness of H-BE interventions on inflammatory parameters, guide future directions for its provision in community-dwelling CS and support GPs with safer anti-inflammatory treatment options in high-risk patients for clinical complications.
Several perioperative factors are responsible for the dysregulation or suppression of the immune system with a possible impact on cancer cell growth and the development of new metastasis. These factors have the potential to directly suppress the immune system and activate hypothalamic-pituitary-adrenal axis and the sympathetic nervous system with a consequent further immunosuppressive effect.
Anesthetics and analgesics used during the perioperative period may modulate the innate and adaptive immune system, inflammatory system, and angiogenesis, with a possible impact on cancer recurrence and long-term outcome. Even if the current data are controversial and contrasting, it is crucial to increase awareness about this topic among healthcare professionals for a future better and conscious choice of anesthetic techniques.
In this article, we aimed to provide an overview regarding the relationship between anesthesia and cancer recurrence. We reviewed the effects of surgery, perioperative factors, and anesthetic agents on tumor cell survival and tumor recurrence.
Background:
A national study analyzing the association between preoperative steroid use and outcomes after pancreatic resections is lacking. The purpose of this study is to evaluate the association between preoperative steroids and outcomes after pancreaticoduodenectomy using a national database.
Materials and methods:
A retrospective analysis of patients undergoing pancreaticoduodenectomy was performed using the National Surgical Quality Improvement Program (NSQIP) database (2014-2019). In addition, we utilized propensity score matching to compare patients on preoperative steroids to those who were not. Outcomes measured included 30-day complications and mortality, need for readmission, a prolonged hospital length of stay, delayed gastric emptying, and pancreatic fistula.
Results:
After propensity score matching, there were 438 patients in the steroid group and 876 patients in the no steroid group. There was no difference in pancreatic fistula (23.8% vs. 21.7%; p-0.3), delayed gastric emptying (21.1% vs.20.1%; p-0.06), major complications (31.8% vs. 30.1%; p-0.1), and mortality (3.5% vs. 3.2%; p-0.6) between the two groups.
Conclusion:
Glucocorticoids did not reduce the incidence of overall complications, postoperative fistula, and delayed gastric emptying following pancreaticoduodenectomy.
