The effect of perioperative administration of glucocorticoids on pulmonary complications after transthoracic oesophagectomy: a systematic review and meta-analysis.
BACKGROUND
Severe pulmonary complications occur frequently following transthoracic oesophagectomy. An exaggerated immunological response is probably a main driving factor, and this might be prevented by perioperative administration of a glucocorticoid.


OBJECTIVE
To determine the clinical benefits and harms of perioperative glucocorticoid during transthoracic oesophagectomy, using pulmonary complications as the primary outcome. Mortality, anastomotic leakage rate and infection were secondary outcomes.


METHODS
A systematic review of interventional trials with a meta-analysis of randomised controlled trials (RCTs).


RESULTS
The search retrieved seven RCTs and four interventional nonrandomised studies. In total, 367 patients received perioperative glucocorticoid and 415 patients did not. A meta-analysis of the RCTs showed no significant effect of glucocorticoid. For pulmonary complications, the pooled risk ratio was 0.69 [95% confidence interval (CI) 0.26 to 1.79], for anastomotic leakage 0.61 (95% CI 0.23 to 1.61) and for infections 1.09 (95% CI 0.41 to 2.93). A subgroup analysis of RCTs that used weight-dependent dosing within 30 min preoperatively showed a pooled risk ratio of 0.28 (95% CI 0.10 to 0.77) for pulmonary complications compared with placebo.


CONCLUSIONS
In this meta-analysis, perioperative administration of glucocorticoid did not affect the risk of pulmonary complications after transthoracic oesophagectomy, nor did it cause adverse effects. A subgroup analysis showed that a weight-dependent dose of methylprednisolone 10 to 30 mg kg within 30 min preoperatively might be the most promising dosing regimen for further research.
From the Department of Surgery (TJW, JPR, RVH), and Department of Anaesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht, The Netherlands (JMD, ACK, HJTAK).
Teus J
TJ
Weijs
Jan M
JM
Dieleman
Jelle P
JP
Ruurda
A Christiaan
AC
Kroese
Hans J T A
HJ
Knape
Richard
R
van Hillegersberg
D016629:Esophagectomy / Q000009:adverse effects; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008171:Lung Diseases / Q000139:chemically induced / Q000209:etiology* / Q000517:prevention & control; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000139:chemically induced / Q000209:etiology* / Q000517:prevention & control; D016896:Treatment Outcome
D005938:Glucocorticoids