Svensk Kirurgi nr 2-19

87 SVENSK KIRURGI • VOLYM 77 • NR 2 • 2019 Figur 3. Compliance till olika parametrar inom ERAS för fransk kolorektalkirurgi. Från Beloeil et al 2019. väl känt att den inflammatoriska reaktionen vid kirurgi kan inducera metastasbenägenhet bland cirkule- rande cancerceller, varför olika försök med inflammationsdämpning och immunmodulering genomförts 17 . Lovande pilotstudier på bland annat bröstcancerpatienter indikerar att kombinationen COX-2-hämmare och betablockad dämpar biomarkö- rer relaterade till metastasbenägenhet, men det återstår att se om detta har effekt på recidivförekomst 18 . Internationell utblick Förhoppningsvis kastar vi kolorektal- kirurger inte ut barnet med badvatt- net, utan vågar pröva postoperativt NSAID mer utförligt med kontrolle- rade studier. Svaret på frågan om vad man som svensk kolorektalkirurg bör göra är nog inte givet, men det kan vara värt med en internationell utblick, som till exempel hur våra franska kollegor hanterat NSAID inom ERAS de senaste åren (Figur 3) 19 .  Referenser 1. Klein M, Andersen LP, Harvald T, Rosen- berg J, Gogenur I. Increased risk of anas- tomotic leakage with diclofenac treatment after laparoscopic colorectal surgery. Dig Surg 2009;26(1): 27-30. 2. Holte K, Andersen J, Jakobsen DH, Kehlet H. Cyclo-oxygenase 2 inhibitors and the risk of anastomotic leakage after fast-track colonic surgery. Br J Surg 2009;96(6): 650-654. 3. Rosenberg J, Harvald T. Severe complica- tions with diclofenac after colonic resec- tion. Dis Colon Rectum 2007;50(5): 685. 4. Klein M, Gogenur I, Rosenberg J. Posto- perative use of non-steroidal anti-inflam- matory drugs in patients with anastomotic leakage requiring reoperation after colo- rectal resection: cohort study based on prospective data. Bmj 2012;345: e6166. 5. Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, Rockall TA, Young-Fadok TM, Hill AG, Soop M, de Boer HD, Urman RD, Chang GJ, Fichera A, Kessler H, Grass F, Whang EE, Fawcett WJ, Carli F, Lobo DN, Rollins KE, Balfour A, Baldini G, Riedel B, Ljungqvist O. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS((R))) Society Recommendations: 2018. World J Surg 2019;43(3): 659-695. 6. Rutegard M, Westermark S, Kverneng Hultberg D, Haapamaki M, Matthies- sen P, Rutegard J. Non-Steroidal Anti- Inflammatory Drug Use and Risk of Anastomotic Leakage after Anterior Resec- tion: A Protocol-Based Study. Dig Surg 2016;33(2): 129-135. 7. Hawkey CJ. COX-1 and COX-2 inhibi- tors. Best Pract Res Clin Gastroenterol 2001;15(5): 801-820. 8. Reisinger KW, Schellekens DH, Bosmans JW, Boonen B, Hulsewe KW, Sastrowi- joto P, Derikx JP, Grootjans J, Poeze M. Cyclooxygenase-2 Is Essential for Colo- rectal Anastomotic Healing. Ann Surg 2017;265(3): 547-554. 9. Yauw ST, Lomme RM, van der Vijver RJ, Hendriks T, van Laarhoven KJ, van Goor H. Diclofenac causes anastomotic leakage in the proximal colon but not in the distal colon of the rat. American journal of surgery 2015;210(2): 382-388. 10. Shakhsheer BA, Versten LA, Luo JN, Defazio JR, Klabbers R, Christley S, Zaborin A, Guyton KL, Krezalek M, Smith DP, Ajami NJ, Petrosino JF, Fle- ming ID, Belogortseva N, Zaborina O, Alverdy JC. Morphine Promotes Coloni- zation of Anastomotic Tissues with Col- lagenase - Producing Enterococcus faecalis and Causes Leak. J Gastrointest Surg 2016;20(10): 1744-1751. 11. Pan T, Peng Z, Tan L, Zou F, Zhou N, Liu B, Liang L, Chen C, Liu J, Wu L, Liu G, Peng Z, Liu W, Ma X, Zhang J, Zhu X, Liu T, Li M, Huang X, Tao L, Zhang Y, Zhang H. Non-Steroidal Anti-Inflamma- tory Drugs (NSAIDs) Potently Inhibit the Replication of Zika Viruses by Inducing the Degradation of AXL. J Virol 2018. 12. Burton TP, Mittal A, Soop M. Nons- teroidal anti-inflammatory drugs and anastomotic dehiscence in bowel surgery: systematic review and meta-analysis of randomized, controlled trials. Dis Colon Rectum 2013;56(1): 126-134. 13. Gorissen KJ, Benning D, Berghmans T, Snoeijs MG, Sosef MN, Hulsewe KW, Luyer MD. Risk of anastomotic leakage with non-steroidal anti-inflammatory drugs in colorectal surgery. Br J Surg 2012;99(5): 721-727. 14. Hakkarainen TW, Steele SR, Bastaworous A, Dellinger EP, Farrokhi E, Farjah F, Florence M, Helton S, Horton M, Pietro M, Varghese TK, Flum DR. Nonsteroidal Anti-inflammatory Drugs and the Risk for Anastomotic Failure: A Report From Washington State's Surgical Care and Outcomes Assessment Program (SCOAP). JAMA surgery 2015;150(3): 223-228. 15. Paulasir S, Kaoutzanis C, Welch KB, Van- dewarker JF, Krapohl G, Lampman RM, Franz MG, Cleary RK. Nonsteroidal Anti- inflammatory Drugs: Do They Increase the Risk of Anastomotic Leaks Following Colorectal Operations? Dis Colon Rectum 2015;58(9): 870-877. 16. Kverneng Hultberg D, Angenete E, Lydrup ML, Rutegard J, Matthiessen P, Rutegard M. Nonsteroidal anti- inflammatory drugs and the risk of anastomotic leakage after anterior resec- tion for rectal cancer. Eur J Surg Oncol 2017;43(10):1908-1914. 17. Tohme S, Simmons RL, Tsung A. Surgery for Cancer: A Trigger for Metastases. Cancer Res 2017;77(7): 1548-1552. 18. Shaashua L, Shabat-Simon M, Haldar R, Matzner P, Zmora O, Shabtai M, Sharon E, Allweis T, Barshack I, Hayman L, Are- valo J, Ma J, Horowitz M, Cole S, Ben- Eliyahu S. Perioperative COX-2 and beta- Adrenergic Blockade Improves Metastatic Biomarkers in Breast Cancer Patients in a Phase-II Randomized Trial. Clin Cancer Res 2017;23(16): 4651-4661. 19. Beloeil H, Slim K, Francophone Group of enhanced recovery after s. Sustainability of anaesthesia components of an enhanced recovery program (ERP) in colorectal and orthopaedics surgery. Anaesth Crit Care Pain Med 2019;38(1): 25-28. NSAID