The effect of perioperative administration of glucocorticoids on pulmonary complications after transthoracic oesophagectomy: a systematic review and meta-analysis

• Published in: European journal of anaesthesiology Vol. 31; no. 12; p. 685
• Main Authors: Weijs, Teus J, Dieleman, Jan M, Ruurda, Jelle P, Kroese, A Christiaan, Knape, Hans J T A, van Hillegersberg, Richard
• Format: Journal Article
• Language: English
• Published: England 01.12.2014
• Subjects: Esophagectomy - adverse effects; Glucocorticoids - administration & dosage; Glucocorticoids - adverse effects; Humans; Lung Diseases - chemically induced; Lung Diseases - etiology; Lung Diseases - prevention & control; Perioperative Care - methods; Postoperative Complications - chemically induced; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Treatment Outcome
• ISSN: 1365-2346
• DOI: 10.1097/EJA.0000000000000093

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