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Perioperative Use of Nonsteroidal Anti-inflammatory Drugs Decreases the Risk of Recurrence of Cancer After Colorectal Resection: A Cohort Study Based on Prospective Data

  • Health Services Research and Global Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Perioperative use of nonsteroidal anti-inflammatory drugs (NSAIDs) is known to reduce inflammatory response in relation to surgery. Inflammation may promote recurrence of cancer, thus inhibition by use of NSAIDs could reduce recurrence after surgery.

Objective

The aim of this study was to examine the association between perioperative use of NSAIDs and cancer recurrence, as well as disease-free survival (DFS) and mortality after colorectal cancer surgery.

Methods

This was a cohort study based on data from a prospective clinical database, electronic medical records, and nationwide registers, and included patients from six major colorectal centers in Denmark. The primary outcome was cancer recurrence, while secondary outcomes included 5-year mortality and DFS.

Results

Overall, 2308 patients undergoing colorectal cancer surgery between 1 January 2006 and 31 December 2009 were included. A total of 909 patients received at least 2 days of treatment with NSAIDs, of whom 702 (77.2%) received ibuprofen and 204 (22.4%) received diclofenac. Cox regression analysis adjusting for NSAIDs resulted in decreased recurrence risk (adjusted hazard ratio [HRadjusted] 0.84, 95% confidence interval [CI] 0.72–0.99; p = 0.042). Competing risk analysis confirmed the finding, with an HRadjusted of 0.76 (95% CI 0.60–0.97; p = 0.026). There was no significant effect on mortality or DFS. Sensitivity analysis of the effect of ibuprofen reported an HRadjusted of 0.83 (95% CI 0.70–1.00; p = 0.047). In restricted analyses of localized disease only (Union for International Cancer Control [UICC] I–II) and elective surgery only, no effect was found (localized: HRadjusted 0.81, 95% CI 0.62–1.06, p = 0.12; elective: HRadjusted 0.85, 95% CI 0.72–1.01, p = 0.063).

Conclusions

Perioperative use of NSAIDs was associated with a reduced risk of cancer recurrence after resection for colorectal cancer. No effect on 5-year mortality or DFS was found.

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Funding

No sources of funding were used to assist in the preparation of this study.

Author information

Authors and Affiliations

  1. Department of Surgery, Center for Surgical Science (CSS), Enhanced Perioperative Oncology Consortium, Zealand University Hospital and University of Copenhagen, Copenhagen, Denmark

    Anders Schack MS, Tina Fransgaard MD, PhD & Ismail Gögenur MD, DMSc

  2. Department of Surgery, Center for Robotics and Minimally Invasive Surgery, Copenhagen University Hospital Herlev, Copenhagen, Denmark

    Mads Falk Klein MD, PhD

  3. Institute for Clinical Medicine, Copenhagen University, Copenhagen, Denmark

    Ismail Gögenur MD, DMSc

  4. Danish Colorectal Cancer Group, Vejle, Denmark

    Mads Falk Klein MD, PhD & Ismail Gögenur MD, DMSc

Authors
  1. Anders Schack MS
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  2. Tina Fransgaard MD, PhD
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  3. Mads Falk Klein MD, PhD
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  4. Ismail Gögenur MD, DMSc
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Contributions

Anders Schack participated in study design, data collection, data analysis, data interpretation, and drafting and critical revision of the manuscript. Tina Fransgaard participated in study design, data collection, data analysis, data interpretation, and critical revision of the manuscript. Mads Klein participated in data collection, data interpretation, and critical revision of the manuscript. Ismail Gögenur participated in study design, data interpretation, and critical revision of the manuscript.

Corresponding author

Correspondence to Anders Schack MS.

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Disclosure

Anders Schack, Tina Fransgaard, Mads Falk Klein, and Ismail Gögenur have no conflicts of interest to declare.

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Schack, A., Fransgaard, T., Klein, M.F. et al. Perioperative Use of Nonsteroidal Anti-inflammatory Drugs Decreases the Risk of Recurrence of Cancer After Colorectal Resection: A Cohort Study Based on Prospective Data. Ann Surg Oncol 26, 3826–3837 (2019). https://doi.org/10.1245/s10434-019-07600-8

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  • DOI: https://doi.org/10.1245/s10434-019-07600-8

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