Abstract
IntroductionResectional 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.MethodAn internet-based survey consisting of 9 questions was circulated via email. Those responses from outside the United Kingdom were excluded.Result74 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.ConclusionThis 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
Resectional surgery remains the mainstay of treatment for colorectal cancer
67 people answered Question 7 (Fig. 2). 94% of respondents think that perioperative steroids reduce postoperative nausea and vomiting, 27% think they reduce the surgical stress response, 10% think they reduce overall complications, 6% think they have no beneficial effect, 4% think they improve long term survival, 3% think they reduce anastomotic leak rate and 3% think they reduce postoperative mortality. 9% of respondents think that they had other beneficial effects which, based on free text responses, were predominantly analgesic effects
Reduction of postoperative nausea and vomiting was the primary aim of perioperative steroid administration
Summary
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. 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. A previous retrospective propensity matched observational study from our department that included patients undergoing elective resectional surgery for colorectal cancer demonstrated a reduction in both the magnitude of the postoperative systemic inflammatory response and the overall complication rate in those patients who received single dose dexamethasone on induction of anaesthesia [11]. While a recent large randomised control trial [10] documented the beneficial effect of single dose dexamethasone on postoperative nausea and vomiting it did not measure the postoperative systemic inflammatory response.
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