title: Efficacy of intraoperative, single-bolus corticosteroid administration to prevent postoperative acute respiratory failure after oesophageal cancer surgery.
abstract: OBJECTIVE
  Respiratory failure from acute lung injury (ALI), acute respiratory distress syndrome (ARDS) and pneumonia are the major cause of morbidity and mortality following an oesophagectomy for oesophageal cancer. This study was performed to investigate whether an intraoperative corticosteroid can attenuate postoperative respiratory failure.
  
  
  METHODS
  Between November 2005 and December 2008, 234 consecutive patients who underwent an oesophagectomy for oesophageal cancer were reviewed. A 125-mg dose of methylprednisolone was administered after performing the anastomosis. ALI, ARDS and pneumonia occurring before postoperative day (POD) 7 were regarded as acute respiratory failure.
  
  
  RESULTS
  The mean age was 64.2 ± 8.7 years. One hundred and fifty-one patients were in the control group and 83 patients in the steroid group. Patients' characteristics were comparable. The incidence of acute respiratory failure was lower in the steroid group (P = 0.037). The incidences of anastomotic leakage and wound dehiscence were not different (P = 0.57 and P = 1.0). The C-reactive protein level on POD 2 was lower in the steroid group (P < 0.005). Multivariate analysis indicates that the intraoperative steroid was a protective factor against acute respiratory failure (P = 0.046, OR = 0.206).
  
  
  CONCLUSIONS
  Intraoperative corticosteroid administration was associated with a decreased risk of acute respiratory failure following an oesophagectomy. The laboratory data suggest that corticosteroids may attenuate the stress-induced inflammatory responses after surgery.
authors: Center for Lung Cancer,  Research Institute and Hospital, National Cancer Center, Goyang,  Korea.
authors: Seong Yong
authors: SY
authors: Park
authors: Hyun-Sung
authors: HS
authors: Lee
authors: Hee-Jin
authors: HJ
authors: Jang
authors: Jungnam
authors: J
authors: Joo
authors: Jae Ill
authors: JI
authors: Zo
mesh_terms: D000208:Acute Disease; D055371:Acute Lung Injury / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D007430:Intraoperative Care; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008776:Methylprednisolone Hemisuccinate / Q000008:administration & dosage*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011014:Pneumonia / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D012131:Respiratory Insufficiency / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D008776:Methylprednisolone Hemisuccinate; D002097:C-Reactive Protein