Is HMG-Co A Reductase Inhibitor Use Associated with Improved Outcomes in Patients Undergoing Colorectal Cancer Resection?

Purpose: HMG-CoA reductase inhibitors (statins) modulate the immune system and have anti-inflammatory effects. It has been proposed that their use in the peri-operative period may reduce surgical complications by modulating the post-operative pro-inflammatory response. This study aims to evaluate the effect of statins on surgical outcomes following colorectal cancer resection. Methods: A retrospective analysis of all colorectal cancer resections performed at University Hospital Birmingham, between June 2008 and July 2013, was conducted. Patients were divided into ‘Statin Users' and ‘Non-statin Users'. Their outcomes and survival were evaluated using univariate, multivariate and cox-regression analysis. Results: 246/703 patients (35.0%) were statin users. There were no differences in disease stage between the groups. Statin users were found to have a higher proportion of colonic, compared to rectal, cancers than non-statin users (60.2% vs. 48.1%, p=0.0023) and a reduced incidence of stoma formation (OR 0.65, 95% CI 0.45-0.95, p=0.0280). Despite significant increases in age, BMI and co-morbidity, statin users had equivalent rates of complications, re-operations, re-admissions and mortality than non-statin users. Statin users were however more likely to be admitted to Critical Care (OR=1.83, 95% CI=1.16-2.87, p=0.0090) and have a prolonged hospital stay (12% increase in LOS, 95% CI=0.002-0.10, p=0.0420). No significant dose related differences were identified in patient outcomes and mortality were observed, although an overall risk reduction in mortality with increasing dose of statin remains possible (HR=0.67, 95% CI=0.41-1.09, p=0.1100). Conclusions: Statin users achieved equivalent short-term and long-term outcomes to non-statin users despite an increased operative risk and their use in the peri-operative period, particularly at high doses, merits further investigation.