Postoperative administration of non-steroidal anti-inflammatory drugs in colorectal cancer surgery does not increase anastomotic leak rate; A systematic review and meta-analysis

被引:34
作者
Arron, Melissa N. N. [1 ,2 ]
Lier, Elisabeth J. [1 ]
de Wilt, Johannes H. W. [1 ]
Stommel, Martijn W. J. [1 ]
van Goor, Harry [1 ]
ten Broek, Richard P. G. [1 ]
机构
[1] Radboud Univ Nijmegen, Dept Surg, Med Ctr, Geert Grootepl Zuid 10,Internal Post 618, NL-6525 GA Nijmegen, Netherlands
[2] Radboud Inst Hlth Sci, Nijmegen, Netherlands
来源
EJSO | 2020年 / 46卷 / 12期
关键词
Colorectal cancer; Anastomotic leak; Non-steroidal anti-inflammatory drugs; Risk factors; RISK-FACTORS; DICLOFENAC CAUSES; MAJOR SURGERY; DOUBLE-BLIND; COLON; RESECTION; RECOVERY;
D O I
10.1016/j.ejso.2020.07.017
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Evidence on the effect of non-steroidal anti-inflammatory drugs (NSAIDs) on anastomotic leak (AL) rate after colorectal surgery is conflicting. Effects of NSAIDs might depend on the underlying disease. This meta-analysis aimed to review the effect of NSAIDs on AL rate in a homogeneous colorectal cancer patient population. Methods: A systematic literature search using MEDLINE and EMBASE database was performed for studies with AL as primary outcome comparing NSAID use in the early postoperative phase with no NSAID administration in colorectal cancer patients undergoing surgical resection. Results: Nine studies including 10,868 patients met the inclusion criteria. The majority, 7689 patients (70.7%) underwent low anterior resection and 3050 patients (28.1%) underwent colonic resection. The pooled incidence of AL was 8.6% (95%CI 7.0-10.0). Overall AL rate after colorectal cancer surgery was not increased in patients using NSAIDs for postoperative analgesia compared to non-users (p = 0.34, RR 1.23; 95%CI 0.81-1.86). This effect remained non-significant after stratification for low anterior resections (p = 0.07). Stratification for colonic resections could not be performed because AL results for this subgroup were not reported separately. Neither non-selective NSAID use nor COX-2 selective NSAID use caused an increased AL rate (p = 0.19, p = 0.26). The results were robust throughout sensitivity analyses. Conclusion: Use of NSAIDs in cohorts with patients undergoing surgical resection for colorectal cancer does not increase overall AL rate. Since results were robust throughout several subgroup and sensitivity analyses, prescription of NSAIDs after colorectal cancer surgery seems safe. (C) 2020 The Authors. Published by Elsevier Ltd.
引用
收藏
页码:2167 / 2173
页数:7
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