Effect of perioperative steroid therapy on the postoperative course of patients with oesophageal cancer.
BACKGROUND
Perioperative steroid therapy is often used in oesophageal cancer surgery and we evaluate the effect of this therapy on the secretory leukocyte protease inhibitor levels in the lungs (a major antiprotease in the conducting airways) and postoperative course in oesophageal cancer patients.


METHODS
Twenty-one patients operated on for oesophageal cancer in 2003-2004 were treated with perioperative steroid therapy (250 mg of methylprednisolone intravenously 1 h before the operation). Fifteen consecutive patients operated on in 2002 served as a control group. Secretory leukocyte protease inhibitor in bronchoalveolar lavage fluid and the postoperative course in the two groups were compared.


RESULTS
The mortality rate was 0% and there was no significant difference in the morbidity rate between the two groups. Days of intubation and systemic inflammatory response syndrome were significantly shorter for the steroid group. The bronchoalveolar lavage fluid secretory leukocyte protease inhibitor level was significantly higher in the steroid group than in the control group on postoperative days 2 and 3. The secretory leukocyte protease inhibitor level on postoperative day 3 was remarkably lower for the patients intubated for > or = 5 days and for those with pulmonary complications.


CONCLUSIONS
Perioperative steroid therapy increased the bronchoalveolar lavage fluid secretory leukocyte protease inhibitor level and reduced the days of intubation and systemic inflammatory response syndrome in patients with oesophagectomy.
Department of General Surgical Science (Surgery I), Gunma University, Graduate School of Medicine, 3-39-22 Showamachi, Maebashi 371-8511, Japan. katukada@topaz.ocn.ne.jp
K
K
Tsukada
T
T
Miyazaki
H
H
Katoh
N
N
Masuda
M
M
Fukuchi
R
R
Manda
Y
Y
Fukai
M
M
Nakajima
M
M
Sohda
H
H
Kimura
H
H
Kuwano
D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D016022:Case-Control Studies; D004938:Esophageal Neoplasms / Q000401:mortality / Q000628:therapy*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007442:Intubation, Intratracheal; D008197:Lymph Node Excision; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D053491:Proteinase Inhibitory Proteins, Secretory; D011506:Proteins / Q000032:analysis; D013908:Thoracotomy
D005938:Glucocorticoids; D053491:Proteinase Inhibitory Proteins, Secretory; D011506:Proteins; D008775:Methylprednisolone