Effect of perioperative glucocorticoid administration on postoperative complications following esophagectomy: A meta‑analysis

Gao,Qiang; Hsiao-Pei,Mok; Wang,Wen‑Ping; Zuo,Xiao-Fei; Chen,Long‑Qi

doi:10.3892/ol.2013.1748

Effect of perioperative glucocorticoid administration on postoperative complications following esophagectomy: A meta‑analysis

Authors:
- Qiang Gao
- Mok Hsiao-Pei
- Wen‑Ping Wang
- Xiao-Fei Zuo
- Long‑Qi Chen
View Affiliations

Affiliations: West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China, Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
Published online on: December 10, 2013 https://doi.org/10.3892/ol.2013.1748
Pages: 349-356

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Perioperative corticosteroid administration is a controversial therapy for improving the short‑term prognosis following surgery. The objective of the current meta‑analysis was to evaluate the effects of the perioperative use of corticosteroids during esophagectomy for esophageal carcinoma. A comprehensive study was performed using references selected from the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, MEDLINE (Ovid databases), EMBASE and three Chinese databases (Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure and VIP Database for Chinese Technical Periodicals). Eligible studies were restricted to randomized clinical trials that reported data from patients undergoing esophagectomy. In addition, treated groups of patients received perioperative corticosteroid administration and control groups received a placebo infusion, such as saline water. The studies evaluated the incidence of postoperative complications and the variation of inflammatory mediators. All extracted data underwent meta‑analysis using Review Manager 5.1 software. Only six studies were eligible for selection. The following parameters were found to be reduced following the use of methylprednisolone: Interleukin (IL)‑6 immediately following surgery and on postoperative days (PODs) 1 and 3; IL‑8 immediately following surgery; and PaO2/FiO2 on POD 3. Moreover, organ failure, cardiovascular complications and pulmonary morbidity were all reduced in patients with corticosteroid usage. Certain factors showed no significant differences between the treated and control groups, including IL‑8 on POD 1, IL‑6 prior to surgery and on POD 5, PaO2/FiO2 following surgery, mortality, anastomotic leakage, severe infection and renal and hepatic failure. Prophylactic administration of methylprednisolone during the perioperative period may reduce the incidence of specific types of postoperative complications and inhibit the postoperative inflammatory reaction. Additional randomized controlled trials must be performed.

View Figures

View References

1	Kikuchi K, Kurokawa H, Matsumoto F, Iwashita S, Miyagi F, Nagai K and Nara N: Responses of cytokines, acute phase proteins, and polymorphonuclear cell elastase to surgical stress in the patients with esophageal cancer. Rinsho Byori. 44:579–584. 1996.(In Japanese).
2	Shimada H, Ochiai T, Okazumi S, Matsubara H, Nabeya Y, Miyazawa Y, et al: Clinical benefits of steroid therapy on surgical stress in patients with esophageal cancer. Surgery. 128:791–798. 2000. View Article : Google Scholar : PubMed/NCBI
3	Kikuchi T and Kugimiya T: Clinical effects of steroid in the perioperative management of patients undergoing extensive esophagectomy. Masui. 51:722–727. 2002.(In Japanese).
4	Yano M, Taniguchi M, Tsujinaka T, Fujiwara Y, Yasuda T, Shiozaki H and Monden M: Is preoperative methylprednisolone beneficial for patients undergoing esophagectomy? Hepatogastroenterology. 52:481–485. 2005.
5	Higgins JPT and Green S: Assessing risk of bias in included studies. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2. John Wiley & Sons, Inc; New York, NY: pp. 183–242. 2009
6	Lagarde SM, de Boer JD, ten Kate FJ, Busch OR, Obertop H and van Lanschot JJ: Postoperative complications after esophagectomy for adenocarcinoma of the esophagus are related to timing of death due to recurrence. Ann Surg. 247:71–76. 2008. View Article : Google Scholar
7	Ni Choileain N and Redmond HP: Cell response to surgery. Arch Surg. 141:1132–1140. 2006.
8	Lin E, Calvano SE and Lowry SF: Inflammatory cytokines and cell response in surgery. Surgery. 127:117–126. 2000. View Article : Google Scholar
9	Kimura F, Shimizu H, Yoshidome H, Ohtsuka M and Miyazaki M: Immunosuppression following surgical and traumatic injury. Surg Today. 40:793–808. 2010. View Article : Google Scholar : PubMed/NCBI
10	Nekhaev IV, Sviridova SP and Kiselevskiĭ MV: Possibilities of immune prevention of pyo-septic complications in cancer patients by granulocytic colony stimulating factors. Anesteziol Reanimatol. Sep–Oct;64–67. 2001.(In Russian).
11	Sato N, Koeda K, Ikeda K, Kimura Y, Aoki K, Iwaya T, et al: Randomized study of the benefits of preoperative corticosteroid administration on the postoperative morbidity and cytokine response in patients undergoing surgery for esophageal cancer. Ann Surg. 236:184–190. 2002. View Article : Google Scholar
12	LeVan TD, Behr FD, Adkins KK, Miesfeld RL and Bloom JW: Glucocorticoid receptor signaling in a bronchial epithelial cell line. Am J Physiol. 272:L838–L843. 1997.
13	Auphan N, DiDonato JA, Rosette C, Helmberg A and Karin M: Immunosuppression by glucocorticoids: inhibition of NF-kappa B activity through induction of I kappa B synthesis. Science. 270:286–290. 1995. View Article : Google Scholar : PubMed/NCBI
14	Munck A, Guyre PM and Holbrook NJ: Physiological functions of glucocorticoids in stress and their relation to pharmacological actions. Endocr Rev. 5:25–44. 1984. View Article : Google Scholar : PubMed/NCBI
15	Takeda S, Takeda S, Kim C, Ikezaki H, Nakanishi K, Sakamoto A, et al: Preoperative administration of methylprednisolone attenuates cytokine-induced respiratory failure after esophageal resection. J Nippon Med Sch. 70:16–20. 2003. View Article : Google Scholar
16	Hashimoto S, Gon Y, Matsumoto K, Maruoka S, Takeshita I, Hayashi S, Asai Y, Jibiki I, Machino T and Horie T: Selective inhibitor of p38 mitogen-activated protein kinase inhibits lipopolysaccharide-induced interleukin-8 expression in human pulmonary vascular endothelial cells. J Pharmacol Exp Ther. 293:370–375. 2000.
17	Yeager MP, Rassias AJ, Pioli PA, Beach ML, Wardwell K, Collins JE, et al: Pretreatment with stress cortisol enhances the human systemic inflammatory response to bacterial endotoxin. Crit Care Med. 37:2727–2732. 2009. View Article : Google Scholar : PubMed/NCBI
18	Xue L, Pan T, Xu Z, Zhao X, Zhong L, Wu L, et al: Multi-factor investigation of early postoperative cardiac arrhythmia for elderly patients with esophageal or cardiac carcinoma. World J Surg. 33:2615–2619. 2009. View Article : Google Scholar
19	Shimizu H, Inoue T, Fujimura M, et al: Cerebral blood flow after surgery for unruptured cerebral aneurysms: effects of surgical manipulation and irrigation fluid. Neurosurgery. 69:677–688. 2011. View Article : Google Scholar
20	Jensen LA, Onyskiw JE and Prasad NG: Meta-analysis of arterial oxygen saturation monitoring by pulse oximetry in adults. Heart Lung. 27:387–408. 1998. View Article : Google Scholar
21	Werner J and Büchler MW: Pancreatic necrosis: pro surgical therapy. Chirurg. 82:507–513. 2011.(In German).
22	Nathan C: Points of control in inflammation. Nature. 420:846–852. 2002. View Article : Google Scholar : PubMed/NCBI
23	Calandra T, Bernhagen J, Metz CN, Spiegel LA, Bacher M, Donnelly T, et al: MIF as a glucocorticoid-induced modulator of cytokine production. Nature. 377:68–71. 1995. View Article : Google Scholar
24	Javeed A and Zhao Y and Zhao Y: Macrophage-migration inhibitory factor: role in inflammatory diseases and graft rejection. Inflamm Res. 57:45–50. 2008. View Article : Google Scholar
25	Gao L, Flores C, Fan-Ma S, Miller EJ, Moitra J, Moreno L, et al: Macrophage migration inhibitory factor in acute lung injury: expression, biomarker, and associations. Transl Res. 150:18–29. 2007. View Article : Google Scholar : PubMed/NCBI
26	Donnelly SC and Bucala R: Macrophage migration inhibitory factor: a regulator of glucocorticoid activity with a critical role in inflammatory disease. Mol Med Today. 3:502–507. 1997. View Article : Google Scholar : PubMed/NCBI
27	Sorrells SF and Sapolsky RM: An inflammatory review of glucocorticoid actions in the CNS. Brain Behav Immun. 21:259–272. 2007. View Article : Google Scholar : PubMed/NCBI
28	Matsutani T, Onda M, Sasajima K and Miyashita M: Glucocorticoid attenuates a decrease of antithrombin III following major surgery. J Surg Res. 79:158–163. 1998. View Article : Google Scholar
29	Takeda S, Ogawa R, Nakanishi K, Kim C, Miyashita M, Sasajima K, et al: The effect of preoperative high dose methylprednisolone in attenuating the metabolic response after oesophageal resection. Eur J Surg. 163:511–517. 1997.PubMed/NCBI
30	Sayama J, Shineha R, Yokota K, Ueda H, Hirayama K and Ooe H: The effectiveness of preoperative steroid therapy in preventing postoperative circulatory system complications in surgery of esophageal cancer. Nihon Kyobu Geka Gakkai Zasshi. 43:652–655. 1995.(In Japanese).