Perioperative glucocorticoid administration for prevention of systemic organ failure in patients undergoing esophageal resection for esophageal carcinoma.
OBJECTIVE
Preoperative glucocorticoid administration has been proposed for reducing postoperative morbidity. This is not widely used before esophageal resection because of incomplete knowledge regarding its effectiveness. The aim here was to assess the effects of preoperative glucocorticoid administration in adults undergoing esophageal resection for esophageal carcinoma.


METHODS
Studies were identified by searching the Cochrane Controlled Trials Register, MEDLINE, EMBASE, Cancer Lit, SCIELO and Cochrane Library, and by manual searching from relevant articles. The last search for clinical trials for this systematic review was performed in December 2004.


METHODS
This review included randomized studies of patients with potentially resectable carcinomas of the esophagus that compared preoperative glucocorticoid administration with placebo.


METHODS
Data were extracted by the same reviewers, and the trial quality was assessed using Jadad scoring. Relative risk and weighted mean difference with 95% confidence limits were used to assess the significance of the difference between the treatment arms.


RESULTS
Four randomized trials involving 146 patients were found. There were no differences in postoperative mortality, sepsis, anastomotic leakage, hepatic and renal failure between the glucocorticoid and placebo groups. There were fewer postoperative respiratory complications (p = 0.005) and multiple postoperative complications (p = 0.004) and lower postoperative plasma interleukin-6 levels (p = 0.00001) with preoperative glucocorticoid administration. There was a higher postoperative PaO2/FiO2 ratio (p = 0.0001) with preoperative glucocorticoid administration.


CONCLUSIONS
Prophylactic administration of glucocorticoids is associated with decreased postoperative complications.
Raimondi
Antônio Marcos
AM
Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, Brazil. raimond11@terra.com.br
Guimarães
Hélio Penna
HP
Amaral
José Luiz Gomes do
JL
Leal
Patrícia Helena Rocha
PH
D002277:Carcinoma / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008775:Methylprednisolone / Q000627:therapeutic use*; D009102:Multiple Organ Failure / Q000517:prevention & control*; D011183:Postoperative Complications; D011300:Preoperative Care; D016032:Randomized Controlled Trials as Topic
D005938:Glucocorticoids; D015850:Interleukin-6; D008775:Methylprednisolone