Efficacy Of Intraoperative Corticosteroid To Prevent Postoperative Respiratory Complication After Transhiatal Esophagectomy
Reza Bagheri1, Reza Afghani2, Seyed Ziaollah Haghi1, Seyed Hossein Fattahi Masoum1, Ali Sadrizadeh1, Maryam Salehi3.
1Lung Disease Research Center, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of, 2Department of General Surgery, 5th of Azar Hospital, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran, Gorgan, Iran, Islamic Republic of, 3Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, Mashhad, Iran, Islamic Republic of.
Background: Esophageal cancer is among the most common malignancies. Hospital mortality in the past decade reduced; but its morbidity is still high. Pulmonary complications are the most common complications after esophageal resection. In this study we examined the effect of steroids administration during surgery to reduce postoperative morbidity with a focus on respiratory complications.
Method: Patients with esophageal cancer who underwent transhiatal esophagectomy, divided into two groups: The intervention group (received 125mg methylprednisolone sodium succinate) & a control group.After surgery, patients admitted in the ICU for a day. Oral feeding initiated on day 7th & patients discharged home on the day 8th or 9th.Postoperative complications included anastomotic fistula, wound infection in the neck & abdomen & pulmonary complications. We analyzed pulmonary complications included pneumonia, ALI or ARDS occurred before the seventh day. The leukocyte count & CRP levels measured on the 2nd & 7th days after surgery.
Results: 60 patients enrolled in the study. Incidence of ARDS, ALI & pneumonia in the control group was 3, 5 & 2 & in steroid group 1, 1 & 1 respectively. CRP levels & blood leukocyte count was similar in two groups on the second day but seventh day values & difference between the two levels between the second & seventh days were significantly different between the two groups.
Conclusion: Preoperative single dose corticosteroids are effective in preventing pulmonary complications after transhiatal esophagectomy. Methylprednisolone reduced the increase in CRP levels after surgery & decreased blood leukocyte count more in postoperative period.
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