Further evaluation revealed that the benefit of ketorolac was “clearly associated” with a reduction in early metastases, both overall and in the high-BMI subgroup, the investigators said.
By contrast, intraoperative diclofenac was not associated with a decrease in distant recurrences, overall (adjusted HR, 1.04; 95% CI, 0.58-1.87, P = .88) or in BMI subgroup analysis, investigators said.
While some might be surprised that a single dose of ketorolac could reduce distant recurrence, it might be explained by the timing of NSAID delivery, they noted. In previous studies, primary tumor removal has been shown to disturb disease homeostasis, and thus might trigger early recurrences.
“Complex system dynamics are exquisitely sensitive on initial conditions, and, therefore, changes occurring in critical early times may be able to cause major changes in system evolution,” the investigators wrote in a discussion of the results.