Effect of prednisolone on local and systemic response in laparoscopic vs. open colon surgery: a randomized, double-blind, placebo-controlled trial.
OBJECTIVE
This study was designed to assess whether preoperative, short-term, intravenously administered high doses of methylprednisolone (30 mg/kg 90 minutes before surgery) influence local and systemic biohumoral responses in patients undergoing laparoscopic or open resection of colon cancer.


METHODS
Fifty-two patients who were candidates for curative colon resection were randomly assigned to laparoscopic or open surgery and, in a double-blind design, assigned to receive methylprednisolone (n = 26) or placebo (n = 26). Pulmonary function, postoperative pain, C-reactive protein, interleukins 6 and 8, and tumor necrosis factor alpha were analyzed, as was patient outcome.


RESULTS
The steroid and placebo groups were well balanced for preoperative variables, as were the subgroups of patients who underwent laparoscopic (methylprednisolone, n = 13; placebo, n = 13) and open surgery (methylprednisolone, n = 13; placebo, n = 13). No adverse events related to steroid administration occurred. In the methylprednisolone groups, significant improvement in pulmonary performance (P = 0.01), pain control (P = 0.001), and length of stay (P = 0.03) were observed independent of the surgical technique. No differences in morbidity or anastomotic leak rate were observed among groups.


CONCLUSIONS
Preoperative administration of methylprednisolone in colon cancer patients may improve pulmonary performance and postoperative pain, and shorten length of stay regardless of the surgical technique used (laparoscopy, open colon resection).
Vignali
Andrea
A
Department of Surgery, IRCCS San Raffaele, University Vita-salute, Milan, Italy. vignali.andrea@hsr.it
Di Palo
Saverio
S
Orsenigo
Elena
E
Ghirardelli
Luca
L
Radaelli
Giovanni
G
Staudacher
Carlo
C
D000368:Aged; D000704:Analysis of Variance; D002097:C-Reactive Protein / Q000378:metabolism; D016009:Chi-Square Distribution; D003110:Colonic Neoplasms / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D015850:Interleukin-6 / Q000378:metabolism; D016209:Interleukin-8 / Q000378:metabolism; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D010149:Postoperative Pain; D010919:Placebos; D011183:Postoperative Complications; D012129:Respiratory Function Tests; D018709:Statistics, Nonparametric; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D005938:Glucocorticoids; D015850:Interleukin-6; D016209:Interleukin-8; D010919:Placebos; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D008775:Methylprednisolone