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. 2019 Oct 11:48:23-28.
doi: 10.1016/j.amsu.2019.10.007. eCollection 2019 Dec.

Attitudes towards the use of perioperative steroids in resectional colorectal cancer surgery in the UK: A qualitative study

Allan M Golder  1 , Stephen T McSorley  1 , Rachel J Kearns  1 , Donald C McMillan  1 , Paul G Horgan  1 , Campbell S Roxburgh  1
Affiliations

Attitudes towards the use of perioperative steroids in resectional colorectal cancer surgery in the UK: A qualitative study

Allan M Golder et al. Ann Med Surg (Lond). .

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.

Keywords: Colorectal; Dexamethasone; Inflammation; Perioperative; Steroid; Surgery.

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Conflict of interest statement

None to declare.

Figures

Fig. 1
Fig. 1
Are there any groups of patients to whom you would be reluctant to give perioperative steroids?.
Fig. 2
Fig. 2
Do you think that single dose steroids given perioperatively for colorectal cancer are associated with.
Fig. 3
Fig. 3
Do you have any concerns regarding the use of perioperative single dose steroids for patients undergoing colorectal cancer resection?.
Fig. 4
Fig. 4
If a trial was set up examining steroids administered at induction of anaesthesia, do you think there would be sufficient equipoise to assess the following?.
See this image and copyright information in PMC

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