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Impact of postoperative NSAIDs (IV-PCA) use on short-term outcomes after laparoscopic gastrectomy for the patients of gastric cancer

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Abstract

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.

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Acknowledgements

The authors thank Professor Hoon Choi of the Department of Anesthesiology for his advice in this study. The authors also wish to acknowledge the financial support of the Catholic Medical Center Research Foundation made in the program year of 2021.

Funding

This study was financially supported by the Korean Gastric Cancer Association.

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Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    So Jung Kim, Chul Hyo Jeon, Han Hong Lee, Kyo Young Song & Ho Seok Seo

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  1. So Jung Kim
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  2. Chul Hyo Jeon
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  3. Han Hong Lee
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Correspondence to Ho Seok Seo.

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So Jung Kim, Chul Hyo Jeon, Han Hong Lee, Kyo Young Song, and Ho Seok Seo have no conflicts of interest or financial ties to disclose.

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Kim, S.J., Jeon, C.H., Lee, H.H. et al. Impact of postoperative NSAIDs (IV-PCA) use on short-term outcomes after laparoscopic gastrectomy for the patients of gastric cancer. Surg Endosc 37, 1123–1131 (2023). https://doi.org/10.1007/s00464-022-09600-4

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  • DOI: https://doi.org/10.1007/s00464-022-09600-4

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