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β-Blockade in Rectal Cancer Surgery: A Simple Measure of Improving Outcomes
Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Surgery, Örebro University Hospital, Örebro, Sweden.
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. (Clinical Epidemiology and Biostatistics)ORCID-id: 0000-0002-3552-9153
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2020 (Engelska)Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 271, nr 1, s. 140-146Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: To ascertain whether regular β-blocker exposure can improve short- and long-term outcomes after rectal cancer surgery.

BACKGROUND: Surgery for rectal cancer is associated with substantial morbidity and mortality. There is increasing evidence to suggest that there is a survival benefit in patients exposed to β-blockers undergoing non-cardiac surgery. Studies investigating the effects on outcomes in patients subjected to surgery for rectal cancer are lacking.

METHODS: All adult patients undergoing elective abdominal resection for rectal cancer over a 10-year period were recruited from the prospectively collected Swedish Colorectal Cancer Registry. Patients were subdivided according to preoperative β-blocker exposure status. Outcomes of interest were 30-day complications, 30-day cause-specific mortality, and 1-year all-cause mortality. The association between β-blocker use and outcomes were analyzed using Poisson regression model with robust standard errors for 30-day complications and cause-specific mortality. One-year survival was assessed using Cox proportional hazards regression model.

RESULTS: A total of 11,966 patients were included in the current study, of whom 3513 (29.36%) were exposed to regular preoperative β-blockers. A significant decrease in 30-day mortality was detected (incidence rate ratio = 0.06, 95% confidence interval: 0.03-0.13, P < 0.001). Deaths of cardiovascular nature, respiratory origin, sepsis, and multiorgan failure were significantly lower in β-blocker users, as were the incidences in postoperative infection and anastomotic failure. The β-blocker positive group had significantly better survival up to 1 year postoperatively with a risk reduction of 57% (hazard ratio = 0.43, 95% confidence interval: 0.37-0.52, P < 0.001).

CONCLUSIONS: Preoperative β-blocker use is strongly associated with improved survival and morbidity after abdominal resection for rectal cancer.

Ort, förlag, år, upplaga, sidor
Lippincott Williams & Wilkins, 2020. Vol. 271, nr 1, s. 140-146
Nationell ämneskategori
Kirurgi Cancer och onkologi
Identifikatorer
URN: urn:nbn:se:oru:diva-74248DOI: 10.1097/SLA.0000000000002970PubMedID: 30048321Scopus ID: 2-s2.0-85077036188OAI: oai:DiVA.org:oru-74248DiVA, id: diva2:1315321
Tillgänglig från: 2019-05-13 Skapad: 2019-05-13 Senast uppdaterad: 2020-01-13Bibliografiskt granskad
Ingår i avhandling
1. The Association Between Beta-Blockade and Clinical Outcomes in the Context of Surgical and Traumatic Stress
Öppna denna publikation i ny flik eller fönster >>The Association Between Beta-Blockade and Clinical Outcomes in the Context of Surgical and Traumatic Stress
2019 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Traumatic injury and major abdominal surgery are areas in general surgery associated with high rates of morbidity and mortality. The overall colorectal cancer surgery mortality rate is around 4%, with that for emergency surgery more than twice as high as for planned. Surgical morbidity varies between 25% and 45%. Around half of trauma patients develop low mood. In one quarter of patients this becomes permanent. Depression is known to impede physical rehabilitation and recovery. The onset of physiological stress, driven by adrenergic hyperactivity following traumatic and surgical injury is hypothesized to contribute to these adverse outcomes. Interest has therefore been sparked into blocking adrenergic receptor activation.

Papers I and II investigated the role of beta-blocker therapy in preventing post-traumatic depression following severe traumatic brain injury (Paper I) and severe extracranial injury (Paper II). The Karolinska University Hospital Trauma Registry was used to identify patients admitted between 2007 and 2011. In Paper I (n = 545), patients on pre-injury beta-blocker therapy were matched to beta-blocker naïve patients with equivalent injury burden. Results revealed that beta-blocked patients exhibited a 60% reduced risk of needing antidepressant therapy within one year of trauma. In Paper II (n = 596), the lack of beta-blocker use before extracranial trauma was linked to a three-fold increase in the risk of antidepressant initiation.

Papers III-V explored the role of pre-operative beta-blocker therapy in patients undergoing surgery for colorectal cancer between 2007 and 2016, identified using the nationwide Swedish Colorectal Cancer Registry. Paper III (n = 3,187) identified a 69% reduction in the risk of 30-day mortality in beta-blocked patients. Paper IV (n = 22,337) outlined long-term survival benefits for patients on beta-blocker therapy prior to undergoing elective surgery for colon cancer. Beta-blocked patients showed a risk reduction of 42% for 1-year all-cause mortality and 18% for 5-year cancerspecific mortality. Similarly, patients on beta-blocker therapy who underwent surgery for rectal cancer demonstrated improved survival up to one year after surgery with a risk reduction of 57% and a reduction in anastomotic failure and infectious complications in Paper V (n = 11,966).

Ort, förlag, år, upplaga, sidor
Örebro: Örebro University, 2019. s. 96
Serie
Örebro Studies in Medicine, ISSN 1652-4063 ; 194
Nyckelord
Beta-blocker therapy, adrenergic hyperactivity, physiological stress, trauma, depression, colorectal cancer, complications, mortality
Nationell ämneskategori
Kirurgi
Identifikatorer
urn:nbn:se:oru:diva-73256 (URN)978-91-7529-277-9 (ISBN)
Disputation
2019-06-05, Örebro universitet, Campus USÖ, hörsal C2, Södra Grev Rosengatan 32, Örebro, 10:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2019-03-21 Skapad: 2019-03-21 Senast uppdaterad: 2019-08-07Bibliografiskt granskad

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Ahl, RebeckaCao, YangSjölin, GabrielLjungqvist, OlleMohseni, Shahin

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