title: Perioperative use of a neutrophil elastase inhibitor in video-assisted thoracoscopic oesophagectomy for cancer.
abstract: BACKGROUND
  This study was undertaken to assess the value of administering perioperative sivelestat sodium hydrate (SSH), a selective neutrophil elastase inhibitor, after video-assisted thoracoscopic oesophagectomy for cancer.
  
  
  METHODS
  Thirty-one consecutive patients with thoracic oesophageal cancer selected to undergo video-assisted thoracoscopic oesophagectomy with lymph node dissection between March 2007 and March 2009 were assigned randomly to a treatment group that received SSH intravenously for 7 days from the beginning of surgery (16 patients) and a control group that received saline (15). The primary endpoint was pulmonary function based on the arterial partial pressure of oxygen/fraction of inspired oxygen ratio (P/F ratio) during the first 9 days after surgery. Secondary endpoints included platelet count, serum C-reactive protein (CRP) concentration, plasma neutrophil elastase-α(1)-antitrypsin complex level, duration of mechanical ventilation and systemic inflammatory response syndrome (SIRS), and length of intensive care unit (ICU) and hospital stay.
  
  
  RESULTS
  The mean P/F ratio of patients who received SSH was significantly higher than that of the control group on postoperative days 1-5 and 7. Duration of mechanical ventilation and SIRS, and length of ICU stay were significantly shorter in the treatment group. Serum CRP concentration on postoperative day 9 was significantly lower (P = 0·048), platelet counts on days 2, 3 and 5 were higher (P = 0·012, P = 0·049 and P = 0·006 respectively), and the incidence of postoperative acute lung injury was significantly lower following SSH treatment (P = 0·023).
  
  
  CONCLUSIONS
  Perioperative sivelestat may maintain postoperative pulmonary function following video-assisted oesophagectomy.
authors.affiliation: Department of Surgery, Gastroenterological Centre, Yokohama City University, Minami-ku, Yokohama, Japan. hirochikam@hotmail.com
authors.forename: H
authors.initials: H
authors.lastname: Makino
authors.forename: C
authors.initials: C
authors.lastname: Kunisaki
authors.forename: T
authors.initials: T
authors.lastname: Kosaka
authors.forename: H
authors.initials: H
authors.lastname: Akiyama
authors.forename: S
authors.initials: S
authors.lastname: Morita
authors.forename: I
authors.initials: I
authors.lastname: Endo
mesh_terms: D000368:Aged; D003422:Critical Care; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005998:Glycine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D007430:Intraoperative Care; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D053491:Proteinase Inhibitory Proteins, Secretory / Q000627:therapeutic use*; D013449:Sulfonamides / Q000627:therapeutic use*; D020775:Thoracic Surgery, Video-Assisted
chemical_list: D053491:Proteinase Inhibitory Proteins, Secretory; D013449:Sulfonamides; C069195:sivelestat; D005998:Glycine