Is preoperative methylprednisolone beneficial for patients undergoing esophagectomy?
OBJECTIVE
This study examined whether or not preoperative administration of methylprednisolone reduces perioperative systemic inflammatory response and thus can offer clinical benefit to patients.


METHODS
Forty patients with thoracic esophageal cancer who were scheduled for esophagectomy with lymphadenectomy were randomly allocated to either of the following two groups: 20 patients received methylprednisolone (500 mg/body) in saline 2 hours before surgery and another 20 patients received a placebo (saline alone). The effects on the early clinical course were assessed by rectal intramucosal pH (pHi) as a marker of systemic oxygenation, water balance, serum cytokine levels and the incidence of postoperative complications. The effects on the late clinical course were examined by comparing patient survival time.


RESULTS
Rectal pHi value, water balance, blood balance and body weight change did not significantly differ between the two groups. Serum proinflammatory cytokine (interleukin-6 and interleukin-8) levels were significantly higher in the control group than the methylprednisolone group 2 hours after surgery. Serum C-reactive protein was also significantly higher in the control group on postoperative day 2 and 3. No significant differences were seen in the incidence of postoperative complications. Survival curves for the two groups did not statistically differ.


CONCLUSIONS
Preoperative methylprednisolone significantly reduces inflammatory cytokine response immediately after surgery for esophageal cancer, but its clinical benefit remains unclear.
Yano
Masahiko
M
Department of Surgery and Clinical Oncology, Graduate School of Medicine, Osaka University, Suita, Japan. myano@surg2.med.osaka-u.ac.jp
Taniguchi
Masaaki
M
Tsujinaka
Toshimasa
T
Fujiwara
Yoshiyuki
Y
Yasuda
Takushi
T
Shiozaki
Hitoshi
H
Monden
Morito
M
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D004311:Double-Blind Method; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008197:Lymph Node Excision; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D011184:Postoperative Period; D011292:Premedication; D016019:Survival Analysis; D013997:Time Factors
D000893:Anti-Inflammatory Agents; D015850:Interleukin-6; D016209:Interleukin-8; D002097:C-Reactive Protein; D008775:Methylprednisolone