The effect of perioperative administration of glucocorticoids on pulmonary complications after transthoracic oesophagectomy

Weijs, Teus J.; Dieleman, Jan M.; Ruurda, Jelle P.; Kroese, A.B.A.; Knape, H; Hillegersberg, Richard van

doi:10.1097/eja.0000000000000093

Cited by 18 publications

(33 citation statements)

References 32 publications

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“…All operations in this study were performed under general anesthesia with epidural analgesia. For standard prophylaxis against lung dysfunction following esophagectomy, methyl-prednisolone (125 mg/body) 8,17) was given at the beginning of the operation 16) and every 24 hours after the initial administration for 4 days (including the operative day). Postoperatively, all patients underwent mechanical ventilation and were cared for in the intensive care unit (ICU).…”

Section: Perioperative Managementmentioning

confidence: 99%

“…5) Oxidative stress and inflammation are believed to play crucial roles in the pathogenesis of impaired oxygenation. 5,6) To improve oxygenation, drugs such as elastase inhibitor 7) or corticosteroids 8,9) are given, but their therapeutic effect has not been confirmed. 7,8,10) Combination therapy with corticosteroids, ascorbic acid, and thiamine has a prominent therapeutic effect on oxidative stress and inflammatory response.…”

Section: Introductionmentioning

confidence: 99%

“…5,6) To improve oxygenation, drugs such as elastase inhibitor 7) or corticosteroids 8,9) are given, but their therapeutic effect has not been confirmed. 7,8,10) Combination therapy with corticosteroids, ascorbic acid, and thiamine has a prominent therapeutic effect on oxidative stress and inflammatory response. 11,12) These favorable effects can provide significant benefits in various conditions in critically ill patients care such as septic shock 13) or acute respiratory distress syndrome.…”

Section: Introductionmentioning

confidence: 99%

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Administration of Corticosteroids, Ascorbic Acid, and Thiamine Improves Oxygenation after Thoracoscopic Esophagectomy

Matsuoka

Shinozaki

Ozawa

et al. 2020

ATCS

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Purpose: The activity of corticosteroids, ascorbic acid, and thiamine against oxidative and inflammatory responses was evaluated in patients undergoing esophagectomy. This study was undertaken to investigate the effect of this combined therapy on lung dysfunction following esophagectomy. Methods: In this retrospective before-after study, we compared the clinical course of consecutive patients undergoing thoracoscopic esophagectomy treated with the combination of corticosteroids, ascorbic acid, and thiamine between June and December 2018 with a control group treated with corticosteroids alone between January 2016 and May 2018. Outcomes included oxygenation (arterial partial pressure of oxygen (PaO 2)/fractional concentration of inspired oxygen (FiO 2) ratios), duration of mechanical ventilation and intensive care unit (ICU) length of stay. Results: In all, 17 patients were included in this study (6 in the combination therapy group and 11 patients in the control group). Mean PaO 2 /F i O 2 ratios in the combined therapy group were significantly higher than in the control group at all points during the observation period (p <0.001). In the combined therapy group, the duration of mechanical ventilation and ICU stay were significantly shorter (p <0.001, p = 0.009). Conclusions: This study suggests that combined therapy including corticosteroids, ascorbic acid, and thiamine may be effective in improving oxygenation after esophagectomy. Additional studies are required to confirm these preliminary findings.

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Section: Perioperative Managementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Administration of Corticosteroids, Ascorbic Acid, and Thiamine Improves Oxygenation after Thoracoscopic Esophagectomy

Matsuoka

Shinozaki

Ozawa

et al. 2020

ATCS

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“…Mortality exceeds 50% when ARDS occurs [2]. ARDS, which is not related to pneumonia or anastomotic leak, results from a massive release of inflammatory cytokines during esophagectomy due to the radical dissection of gastro-enteral organs [3][4][5] and one lung ventilation (OLV) which increases inflammatory cytokines in both dependent and non-dependent lungs [6]. Excessive neutrophils recruited in response to the pro-inflammatory cytokines increase pulmonary vascular permeability [7].…”

Section: Introductionmentioning

confidence: 99%

“…Preventive administration of corticosteroid was reported to reduce ARDS after esophagectomy by inhibiting inflammatory responses [9,10]. However, there are also studies that showed no beneficial effect of corticosteroid on ARDS [3,11]. Moreover, there are concerns that corticosteroid can impair the healing process of surgical wounds and produce leakage of the anastomosis site by antiinflammatory effects and antagonistic effects on growth factors [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

The effect of preventive use of corticosteroids on postoperative complications after esophagectomy: A retrospective cohort study

Jeong

Choi

Ahn

et al. 2019

Preprint

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Background: Although corticosteroids were known to reduce acute respiratory distress syndrome (ARDS) after esophagectomy, the efficacy of corticosteroid remains debatable. Moreover, the risk of anastomosis leakage or infection, which relates to the administration of corticosteroid is another concern. Therefore, we compared the incidence of composite complications between patients who received or not the preventive administration of corticosteroid in esophagectomy. Methods: All patients who underwent esophagectomy from 2010 to 2015 at a tertiary care university hospital, were reviewed in this retrospective study (n=1,041). Patients were divided into Steroid (n=120) and Control (n=860) groups based on the preventive administration of corticosteroid during surgery. The primary endpoint was the incidence of composite complications (acute respiratory distress syndrome, wound dehiscence, and infection). Comparison between the two groups was performed after adjustment of co-variables. Results: The incidence of composite complications was not different between Steroid and Control group (21.7% vs 17.4%, respectively; P=0.26). Incidence of complications in each category between Steroid and Control groups were not significantly different: acute respiratory distress syndrome (5.0% vs 3.8%; P=0.46), graft dehiscence (6.7% vs 4.8%; P=0.37), and infection (15.8% vs 12.8%; P=0.36). After propensity score matching, the difference between the groups was also not significant. In multivariable analysis, age, lower body mass index, diabetes mellitus and duration of operation were independent risk factors of composite complications. Additionally, intraoperative vasopressor was a risk factor of graft dehiscence (odds ratio, 2.06; 95% confidence interval, 1.03-4.12; P=0.0407). Conclusions: The preventive use of corticosteroid was not related to the incidence of composite complications after esophagectomy. Application of corticosteroid for prevention of acute respiratory distress syndrome is not recommended due to its lack of apparent benefit. Keywords: Acute respiratory distress syndrome, corticosteroid, esophagectomy.

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Pharmacological treatment to reduce pulmonary morbidity after esophagectomy

Shinozaki

Matsuoka

Ozawa

2021

Annals of Gastroent Surgery

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Esophagectomy for esophageal cancer is one of the most invasive procedures in gastrointestinal surgery. An invasive surgical procedure causes postoperative lung injury through the surgical procedure and one‐lung ventilation during anesthesia. Lung injury developed by inflammatory response to surgical insults and oxidative stress is associated with pulmonary morbidity after esophagectomy. Postoperative pulmonary complications negatively affect the long‐term outcomes; therefore, an effort to reduce lung injury improves overall survival after esophagectomy. Although significant evidence has not been established, various pharmacological treatments for reducing lung injury, such as administration of a corticosteroid, neutrophil elastase inhibitor, and vitamins are considered to have efficacy for pulmonary morbidity. In this review we survey the following topics: mediators during the perioperative periods of esophagectomy and the efficacy of pharmacological therapies for patients with esophagectomy on pulmonary complications.

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The effect of perioperative administration of glucocorticoids on pulmonary complications after transthoracic oesophagectomy

Cited by 18 publications

References 32 publications

Administration of Corticosteroids, Ascorbic Acid, and Thiamine Improves Oxygenation after Thoracoscopic Esophagectomy

Administration of Corticosteroids, Ascorbic Acid, and Thiamine Improves Oxygenation after Thoracoscopic Esophagectomy

The effect of preventive use of corticosteroids on postoperative complications after esophagectomy: A retrospective cohort study

Pharmacological treatment to reduce pulmonary morbidity after esophagectomy

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