# Sugammadex Versus Neostigmine in Return to Intended Oncological Therapy After Gastrointestinal Cancer Surgery: A Retrospective Study

## TL;DR

This study compared sugammadex and neostigmine to see which helps cancer surgery patients return to treatment faster, but found little difference between the two drugs.

## Contribution

The study is the first to evaluate the impact of sugammadex versus neostigmine on return to oncological therapy after gastrointestinal cancer surgery.

## Key findings

- Sugammadex and neostigmine showed similar rates of return to oncological therapy within 90 and 180 days.
- There was a modest increase in radiotherapy resumption with neostigmine at 90 and 180 days.
- Perioperative outcomes like hospital stay and ICU admission were not significantly different between the two drugs.

## Abstract

This research investigated whether the use of sugammadex, compared to neostigmine, to restore muscle strength after muscle relaxation during general anesthesia improves or accelerates patients’ return to cancer therapies. For this, we used a cohort of patients with abdominal cancers who had surgery at a major tertiary cancer center and received neostigmine or sugammadex to restore muscle function. This study showed that the use of either drug did not significantly impact the overall return to oncological therapies after cancer surgery.

Background: Adjuvant therapies improve disease-free and cancer-specific survival in digestive tract malignancies. Return to intended oncological therapy (RIOT) measures how promptly patients resume these treatments after cancer resection. Because sugammadex has demonstrated superior postoperative outcomes compared to neostigmine, we hypothesize that its use may increase the likelihood and timeliness of RIOT in patients undergoing digestive tract cancer surgery. Methods: Adults (≥18 years) undergoing gastrointestinal, hepatobiliary cancer resection, or liver resection for limited metastases between January 2016 and December 2017 were retrospectively analyzed. Patients were grouped by neuromuscular blockade reversal agent (neostigmine vs. sugammadex). The primary outcome was RIOT within 90 days; secondary outcomes included RIOT within 180 days, time-to-RIOT, hospital length of stay, ICU admission, and readmissions. Results: Of 4358 records screened, 1081 met the inclusion criteria: 273 (25.2%) patients with neostigmine and 808 (74.8%) with sugammadex. Patients in the neostigmine group were slightly younger, and racial distribution differed modestly, but sex, BMI, ASA class, comorbidity, cancer type, and stage were comparable. Median reversal doses were 5 mg and 200 mg, respectively. Anesthesia duration, hospital and ICU length of stay, readmissions, and ICU use showed no significant differences. RIOT frequency was also similar across groups, except for modestly higher radiotherapy resumption with neostigmine at 90 and 180 days. Overall, perioperative and oncological outcomes were largely comparable between groups. Conclusions: Sugammadex and neostigmine showed similar RIOT rates, with only a modest difference in radiotherapy resumption. Larger studies are needed to elucidate the potential benefits of sugammadex, particularly regarding long-term oncological outcomes and treatment continuity.