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Meta-Analysis
. 2006 Mar 2;124(2):112-5.
doi: 10.1590/s1516-31802006000200013.

Perioperative glucocorticoid administration for prevention of systemic organ failure in patients undergoing esophageal resection for esophageal carcinoma

Antônio Marcos Raimondi  1 , Hélio Penna Guimarães, José Luiz Gomes do Amaral, Patrícia Helena Rocha Leal
Affiliations
Meta-Analysis

Perioperative glucocorticoid administration for prevention of systemic organ failure in patients undergoing esophageal resection for esophageal carcinoma

Antônio Marcos Raimondi et al. Sao Paulo Med J. .

Abstract
in English, Portuguese

Context and objective: Preoperative glucocorticoid administration has been proposed for reducing postoperative morbidity. This is not widely used before esophageal resection because of incomplete knowledge regarding its effectiveness. The aim here was to assess the effects of preoperative glucocorticoid administration in adults undergoing esophageal resection for esophageal carcinoma.

Search strategy: Studies were identified by searching the Cochrane Controlled Trials Register, MEDLINE, EMBASE, Cancer Lit, SCIELO and Cochrane Library, and by manual searching from relevant articles. The last search for clinical trials for this systematic review was performed in December 2004.

Selection criteria: This review included randomized studies of patients with potentially resectable carcinomas of the esophagus that compared preoperative glucocorticoid administration with placebo.

Data collection and analysis: Data were extracted by the same reviewers, and the trial quality was assessed using Jadad scoring. Relative risk and weighted mean difference with 95% confidence limits were used to assess the significance of the difference between the treatment arms.

Results: Four randomized trials involving 146 patients were found. There were no differences in postoperative mortality, sepsis, anastomotic leakage, hepatic and renal failure between the glucocorticoid and placebo groups. There were fewer postoperative respiratory complications (p = 0.005) and multiple postoperative complications (p = 0.004) and lower postoperative plasma interleukin-6 levels (p = 0.00001) with preoperative glucocorticoid administration. There was a higher postoperative PaO2/FiO2 ratio (p = 0.0001) with preoperative glucocorticoid administration.

Conclusion: Prophylactic administration of glucocorticoids is associated with decreased postoperative complications.

CONTEXTO E OBJETIVO:: A administração de glicocorticóides tem sido proposta para reduzir a morbidade após operações, porém, não é largamente usada antes da ressecção do esôfago devido ao fato de não haver ainda conhecimentos suficientes sobre sua eficácia. O objetivo do trabalho é verificar os efeitos da administração pré-operatória de glicocorticóides em pacientes submetidos a esofagectomia por carcinoma de esôfago.

ESTRATÉGIA DE PESQUISA:: As fontes utilizadas foram: Medline, Embase, Cancerlit, SciELO, Base de Dados de Ensaios Clínicos Controlados da Colaboração Cochrane e busca manual de referências. O término da pesquisa ocorreu em dezembro de 2004.

CRITÉRIOS DE SELEÇÃO:: Estudos randomizados de pacientes com carcinoma esofágico que compararam glicocorticóide com placebo administrados antes das esofagectomias.

ANÁLISE E COLETA DE DADOS:: Os dados foram coletados pelos mesmos revisores e a qualidade dos estudos foi avaliada usando-se o escore de Jadad. A metanálise foi realizada utilizando-se o risco relativo e diferença de média ponderada entre tratamento e placebo (intervalos de confiança de 95%).

RESULTADOS:: Quatroensaios envolvendo 146 pacientes foram localizados. Não ocorreram diferenças na mortalidade pós-operatória e nas incidências de sepse, deiscência de anastomose e insuficiências renal e hepática entre glicocorticóide e placebo. Houve decréscimo na incidência de complicações respiratórias pós-operatórias (p = 0,005), múltiplas complicações (p = 0,004) e níveis plasmáticos de interleucina-6 (p = 0,00001) nos pacientes que receberam glicocorticóide pré-operatório. Houve incremento na relação PaO2/FiO2 pós-operatória (p = 0,0001) no grupo que recebeu glicocorticóide pré-operatório.

CONCLUSÃO:: A administração pré-operatória de glicocorticóide foi associada com um decréscimo nas complicações pós-operatórias.

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Conflict of interest statement

Conflict of interest: None

Figures

Figure 1
Figure 1. Mean postoperative PaO2/FiO2 ratio in two studies included in this meta-analysis.
Figure 2
Figure 2. Postoperative respiratory complications in four studies included in this meta-analysis.
See this image and copyright information in PMC

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