Background

Further data are necessary to evaluate the risk of complications associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs) postoperatively. This study aimed to determine the correlation between the use of NSAIDs in intravenous patient-controlled analgesia (IV-PCA) and postoperative complications after laparoscopic gastrectomy in patients with gastric cancer.

Methods

This retrospective, single-center study was conducted. The study population comprised 2150 patients who underwent laparoscopic gastrectomy for gastric cancer treatment. They were divided into two groups: non-NSAIDs (n = 1215) and NSAIDs (n = 935) according to their use of the drugs. Clinicopathologic characteristics, operative details, postoperative complications within 30 days, risk factors for complications, and survival were analyzed.

Results

Of the 2150 patients, 935 (43.49%) used NSAIDs. The overall complication rate showed no significant difference between the NSAIDs and non-NSAIDs groups (22.7% vs. 20.7%, p = 0.280), while the rates of anastomotic leakage and duodenal leakage were higher in the NSAID group (2.4% vs. 0.7%, p = 0.002 and 1.8% vs. 0.6%, p = 0.007, respectively). The rates of intra-abdominal bleeding and intra-abdominal abscess were significantly higher in the NSAID group (2.1% vs. 0.7%, p = 0.005 and 1.5% vs. 0.4%, p = 0.008, respectively). However, postoperative ileus occurred more frequently in the non-NSAID group (3.0% vs. 1.4%, p = 0.015). On multivariate analysis, NSAID use was an independent risk factor for early postoperative complications (1.303 [1.042–1.629], p = 0.020). Meanwhile, the NSAID group showed no differences in overall survival at each pathological stage.

Conclusion

Postoperative NSAID use by IV-PCA is associated with anastomotic leakage, duodenal stump leakage, intra-abdominal bleeding, and intra-abdominal abscess in patients who underwent laparoscopic gastrectomy for gastric cancer. Caution is advised when NSAIDs are used peri-operatively.

Graphical abstract

中文翻译：

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术后非甾体抗炎药（IV-PCA）使用对胃癌患者腹腔镜胃切除术后短期结局的影响

背景

需要进一步的数据来评估与术后使用非甾体抗炎药 (NSAID) 相关的并发症风险。本研究旨在确定非甾体抗炎药在胃癌患者腹腔镜胃切除术后静脉自控镇痛 (IV-PCA) 中的使用与术后并发症之间的相关性。

方法

进行了这项回顾性单中心研究。研究人群包括 2150 名接受腹腔镜胃切除术治疗胃癌的患者。 根据药物的使用情况，他们被分为两组：非 NSAIDs（n  = 1215）和 NSAIDs（n = 935）。分析了临床病理特征、手术细节、术后 30 天内的并发症、并发症的危险因素和生存情况。

结果

在 2150 名患者中，935 名 (43.49%) 使用了非甾体抗炎药。NSAIDs 组和非 NSAIDs 组的总体并发症发生率无显着差异（22.7% vs. 20.7%，p  = 0.280），而 NSAIDs 组的吻合口漏和十二指肠漏发生率更高（2.4% vs. 0.7） %，p  = 0.002 和 1.8% 对比 0.6%，p  = 0.007）。NSAID 组的腹内出血和腹内脓肿发生率显着更高（分别为 2.1% 对 0.7%，p  = 0.005 和 1.5% 对 0.4%，p  = 0.008）。然而，非 NSAID 组术后肠梗阻的发生率更高（3.0% 对 1.4%，p = 0.015）。在多变量分析中，NSAID 的使用是术后早期并发症的独立危险因素 (1.303 [1.042–1.629]，p  = 0.020)。同时，非甾体抗炎药组在每个病理阶段的总生存期没有差异。

结论

IV-PCA 术后使用 NSAID 与因胃癌接受腹腔镜胃切除术的患者发生吻合口漏、十二指肠残端漏、腹内出血和腹内脓肿有关。建议在围手术期使用非甾体抗炎药时要小心。

图形概要