Attitudes towards the use of perioperative steroids in resectional colorectal cancer surgery in the UK: A qualitative study. (December 2019)

• Record Type: Journal Article
• Authors: Golder, Allan M.; McSorley, Stephen T.; Kearns, Rachel J.; McMillan, Donald C.; Horgan, Paul G.; Roxburgh, Campbell S.
• Is Part Of: Annals of medicine and surgery. Volume 48(2020)
• Page Start: 23
• Page End: 28
• Publication Date: 2019-12
• Subjects: Colorectal -- Dexamethasone -- Inflammation -- Steroid -- Surgery -- Perioperative; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2019.10.007
• Languages: English
• ISSNs: 2049-0801

Abstract

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 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. Highlights: Currently, the use of perioperative steroids is common, although not routine in resectional colorectal surgery. Perioperative steroids are currently administered with the aim of reducing postoperative nausea and vomiting. There is sufficient equipoise to carry out an RCT studying perioperative dexamethasone and outcomes in colorectal resection.