Safety of Dexamethasone Used after Operation of Anastomotic Colorectal Resection in Patients with Colorectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Tinghan ^1,2,3 , TAI Yang ^1,2,3 , YANG Guangchao ^1,2,3 , DONG Yajie ^1,2,3 , WANG Xiaodong ^1,2 , LI Li ^1,2

1.Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;;
2.West China Hospital MCQ Team, Sichuan University, Chengdu 610041, China;;
3.West China Medical School, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Glucocorticoid; Dexamethasone; Colorectal cancer; Fast-track surgery

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To explore the value and clinical safety of low-dose dexamethasone used after operation of anastomotic colorectal resection with fast-track surgery in patients with colorectal cancer.
Methods Between January 2008 and December 2009, 470 patients undergoing anastomotic colorectal resection were analyzed retrospectively, who were divided into dexamethasone group and control group according to the use of low-dose dexamethasone treatment or not after operation. Postoperative adverse effect, complications, and early rehabilitations were studied.
Results There was no statistical significance in postoperative incidence of adverse effect or complications between two groups (P gt;0.05). In early rehabilitation, first ambulation of patients in the dexamethasone group was significantly earlier than that in the control group (P lt;0.05), while there was no statistical significance in first time of passing flatus, stool, and oral intake, the retain time of nasogastric tubes, urinary catheter, and drains, and postoperative hospital stay (P gt;0.05).
Conclusion Using low-dose dexamethasone after operation anastomotic colorectal resection in patients with colorectal cancer is safe and may have potential to enhance recovery after operation.

Citation： YANG Tinghan,TAI Yang,YANG Guangchao,DONG Yajie,WANG Xiaodong,LI Li,.. Safety of Dexamethasone Used after Operation of Anastomotic Colorectal Resection in Patients with Colorectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(7): 751-754. doi: Copy

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13.	Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection [J]. Clin Nutr, 2005; 24(3): 466477.
14.	Kehlet H. Manipulation of the metabolic response in clinical practice [J]. World J Surg, 2000; 24(6): 690695.
15.	Lee Y, Lai HY, Lin PC, et al. Dexamethasone prevents postoperative nausea and vomiting more effectively in women with motion sickness [J]. Can J Anaesth, 2003; 50(3): 232237.
16.	Kirdak T, Yilmazlar A, Cavun S, et al. Does single, lowdose preoperative dexamethasone improve outcomes after colorectal surgery based on an enhanced recovery protocol? Doubleblind, randomized clinical trial [J]. Am Surg, 2008; 74(2): 160167.
17.	Telem DA, Chin EH, Nguyen SQ, et al. Risk factors for anastomotic leak following colorectal surgery: a casecontrol study [J]. Arch Surg, 2010; 145(4): 371376.
18.	Rovera F, Dionigi G, Boni L, et al. Infectious complications in colorectal surgery [J]. Surg Oncol, 2007; 16 Suppl 1: S121S124.
19.	Schulze S, Andersen J, Overgaard H, et al. Effect of prednisolone on the systemic response and wound healing after colonic surgery [J]. Arch Surg, 1997; 132(2): 129135.
20.	Paddison JS, Booth RJ, Fuchs D, et al. Peritoneal inflammation and fatigue experiences following colorectal surgery: a pilot study [J]. Psychoneuroendocrinology, 2008; 33(4): 446454.
21.	Sipos P, Ondrejka P. “Fast track” colorectal surgery [J]. Orv Hetil, 2007; 148(21): 963969.
22.	Carli F, Charlebois P, Baldini G, et al. An integrated multidisciplinary approach to implementation of a fasttrack program for laparoscopic colorectal surgery [J]. Can J Anaesth, 2009; 56(11): 837842.
23.	刘展, 汪晓东, 李立. 结直肠外科快速康复流程加速直肠癌术后康复的临床研究 [J]. 中华胃肠外科杂志, 2008; 11(6): 551553.
24.	肖凌, 李蔚, 麦玲, 等. 快速流程模式下术后限制补液对不同手术方案直肠癌患者康复情况的影响 [J]. 中国普外基础与临床杂志, 2010; 17(2): 190194.
25.	周寅, 杨廷翰, 汪晓东, 等. 早期经口进食在结直肠癌术后快速流程模式中的应用 [J] 中国普外基础与临床杂志, 2010; 17(5): 500503.

1. Holte K, Kehlet H. Perioperative singledose glucocorticoid administration: pathophysiologic effects and clinical implications [J]. J Am Coll Surg, 2002; 195(5): 694712.
2. Rosin D. Dexamethasone in patients undergoing elective laparoscopic cholecystectomy improves postoperative symptoms [J]. World J Surg, 2010; 34(5): 901902.
3. Bisgaard T, Klarskov B, Kehlet H, et al. Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: a randomized doubleblind placebocontrolled trial [J]. Ann Surg, 2003; 238(5): 651660.
4. Thomas S, Beevi S. Epidural dexamethasone reduces postoperative pain and analgesic requirements [J]. Can J Anaesth, 2006; 53(9): 899905.
5. 吕东吴, 汪晓东, 阳川华, 等. 结直肠肿瘤多学科协作诊治模式的数据库初期建设现状 [J]. 中国普外基础与临床杂志, 2007; 14(6): 713715.
6. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery [J]. Lancet, 2003; 362(9399): 19211928.
7. Delaney CP, Zutshi M, Senagore AJ, et al. Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection [J]. Dis Colon Rectum, 2003; 46(7): 851859.
8. Anderson AD, McNaught CE, MacFie J, et al. Randomized clinical trial of multimodal optimization and standard perioperative surgical care [J]. Br J Surg, 2003; 90(12): 14971504.
9. Maessen JM, Dejong CH, Kessels AG, et al. Length of stay: an inappropriate readout of the success of enhanced recovery programs [J]. World J Surg, 2008; 32(6): 971975.
10. Basse L, Thorbl JE, Lssl K, et al. Colonic surgery with accelerated rehabilitation or conventional care [J]. Dis Colon Rectum, 2004; 47(3): 271277.
11. Kehlet H. Fasttrack colorectal surgery [J]. Lancet, 2008; 371(9615): 791793.
12. Hasenberg T, Keese M, Lngle F, et al. “Fasttrack” colonic surgery in Austria and Germanyresults from the survey on patterns in current perioperative practice [J]. Colorectal Dis, 2009; 11(2): 162167.
13. Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection [J]. Clin Nutr, 2005; 24(3): 466477.
14. Kehlet H. Manipulation of the metabolic response in clinical practice [J]. World J Surg, 2000; 24(6): 690695.
15. Lee Y, Lai HY, Lin PC, et al. Dexamethasone prevents postoperative nausea and vomiting more effectively in women with motion sickness [J]. Can J Anaesth, 2003; 50(3): 232237.
16. Kirdak T, Yilmazlar A, Cavun S, et al. Does single, lowdose preoperative dexamethasone improve outcomes after colorectal surgery based on an enhanced recovery protocol? Doubleblind, randomized clinical trial [J]. Am Surg, 2008; 74(2): 160167.
17. Telem DA, Chin EH, Nguyen SQ, et al. Risk factors for anastomotic leak following colorectal surgery: a casecontrol study [J]. Arch Surg, 2010; 145(4): 371376.
18. Rovera F, Dionigi G, Boni L, et al. Infectious complications in colorectal surgery [J]. Surg Oncol, 2007; 16 Suppl 1: S121S124.
19. Schulze S, Andersen J, Overgaard H, et al. Effect of prednisolone on the systemic response and wound healing after colonic surgery [J]. Arch Surg, 1997; 132(2): 129135.
20. Paddison JS, Booth RJ, Fuchs D, et al. Peritoneal inflammation and fatigue experiences following colorectal surgery: a pilot study [J]. Psychoneuroendocrinology, 2008; 33(4): 446454.
21. Sipos P, Ondrejka P. “Fast track” colorectal surgery [J]. Orv Hetil, 2007; 148(21): 963969.
22. Carli F, Charlebois P, Baldini G, et al. An integrated multidisciplinary approach to implementation of a fasttrack program for laparoscopic colorectal surgery [J]. Can J Anaesth, 2009; 56(11): 837842.
23. 刘展, 汪晓东, 李立. 结直肠外科快速康复流程加速直肠癌术后康复的临床研究 [J]. 中华胃肠外科杂志, 2008; 11(6): 551553.
24. 肖凌, 李蔚, 麦玲, 等. 快速流程模式下术后限制补液对不同手术方案直肠癌患者康复情况的影响 [J]. 中国普外基础与临床杂志, 2010; 17(2): 190194.
25. 周寅, 杨廷翰, 汪晓东, 等. 早期经口进食在结直肠癌术后快速流程模式中的应用 [J] 中国普外基础与临床杂志, 2010; 17(5): 500503.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Safety of Dexamethasone Used after Operation of Anastomotic Colorectal Resection in Patients with Colorectal Cancer

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