Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
School of Medical Sciences, Orebro University, Orebro, Sweden.
Ann Surg. 2020 Jan;271(1):140-146. doi: 10.1097/SLA.0000000000002970.
To ascertain whether regular β-blocker exposure can improve short- and long-term outcomes after rectal cancer surgery.
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.
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.
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).
Preoperative β-blocker use is strongly associated with improved survival and morbidity after abdominal resection for rectal cancer.
确定常规β受体阻滞剂暴露是否能改善直肠癌手术后的短期和长期结局。
直肠癌手术与大量发病率和死亡率相关。越来越多的证据表明，接受非心脏手术的β受体阻滞剂暴露的患者有生存获益。缺乏研究调查对接受直肠癌手术的患者的结局的影响。
在 10 年期间，从瑞典结直肠癌登记处前瞻性收集的所有接受择期腹部切除术的成年直肠癌患者均被招募。根据术前β受体阻滞剂暴露状态对患者进行分组。关注的结局是 30 天并发症、30 天特定原因死亡率和 1 年全因死亡率。使用泊松回归模型分析β受体阻滞剂使用与结局之间的关系，30 天并发症和特定原因死亡率采用稳健标准误差。使用 Cox 比例风险回归模型评估 1 年生存率。
本研究共纳入 11966 例患者，其中 3513 例（29.36%）接受常规术前β受体阻滞剂治疗。30 天死亡率显著降低（发病率比=0.06，95%置信区间：0.03-0.13，P<0.001）。β受体阻滞剂使用者心血管原因、呼吸源、脓毒症和多器官衰竭的死亡明显较低，术后感染和吻合口失败的发生率也较低。β受体阻滞剂阳性组在术后 1 年的生存率显著提高，风险降低 57%（风险比=0.43，95%置信区间：0.37-0.52，P<0.001）。
术前β受体阻滞剂的使用与腹部直肠癌切除术后的生存和发病率的改善密切相关。
