Preoperative glucocorticoid administration has been proposed to reducing postoperative morbidity. It isn′t widely used before esophageal resection due incomplete knowledge of its effectiveness.Objective:To assess the effects of preoperative glucocorticoid administration in adults underwent esophageal resection for esophageal carcinoma.
SEARCH STRATEGY: Studies were identified by searching the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CancerLit, SCIELO, Cochrane Library and handsearching from relevant articles. The date of the last search for clinical trials for this systematic review was December 2004. SELECTION CRITERIA: This review included randomized of patients with potentially resectable carcinomas of the esophagus that compare glucocorticoid with placebo before surgeries. DATA COLLECTION & ANALYSIS: Data were extracted by the same reviewers, and the trial quality was assessed using the Jadad scoring. Relative risk and weight mean difference with 95% confidence limits were used to assess the significance of the difference between the treatment arms.
There were four randomized trials involving 146 patients. There weren’t differences in postoperative mortality, sepsis, anastomotic leakage, hepatic and renal failure between glucocorticoid and placebo groups. There was a decrease in postoperative respiratory complications (p = 0.005), multiple postoperative complications (p = 0.004) and postoperative plasma levels of interleukin-6 (p = 0.00001) with preoperative glucocorticoid administration. There was a increase in postoperative PaO2/FiO2 ratio (p = 0.0001) with preoperative glucocorticoid administration.
Prophylactic administration of glucocorticoids is associated with a amelioration in postoperative PaO2/FiO2 relation.
Perioperative methylprednisolone administration represented a potentially important biologic modifier of postoperative inflammatory responses and organ dysfunction.
Antonio Raimondi, None.