Efficacy of Intraoperative, Single-Bolus Corticosteroid Dose to Prevent Postoperative Respiratory Complication after Transhiatal Esophagectomy

Document Type : Research Paper


1 Thoracic Surgeon, department of general surgery, 5th of Azar Hospital, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.

2 Thoracic Surgeon, Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

3 Thoracic Surgeon, , Lung Disease Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

4 Thoracic Surgeon, Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

5 Community Medicine Specialist, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Introduction: 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.
Material and Methods: Patients with esophageal cancer who underwent transhiatal esophagectomy, randomly divided into two groups to thirty patients: The intervention group (received 125mg methylprednisolone sodium succinate). After surgery, patients admitted in the ICU for a day. Oral feeding initiated on day 7th and patients discharged home on the day 8th or 9th.
Postoperative complications included anastomotic fistula, wound infection in the neck and abdomen and pulmonary complications. We analyzed pulmonary complications included pneumonia, Acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) occurred before the seventh day. The leukocyte counts and CRP levels measured on the 2nd and 7th days after surgery.
Results: 60 patients enrolled in the study. Incidence of ARDS, ALI and pneumonia in the control group was 3, 5 and 2 and in steroid group 1, 1 and 1 respectively. CRP levels and blood leukocyte count was similar in two groups on the second day but seventh day values and difference between the two levels between the second and seventh days were significantly different between the two groups (p<0.001).
Conclusion: Intraoperative single dose corticosteroids are effective in preventing pulmonary complications after transhiatal esophagectomy. Methylprednisolone reduced the increase in CRP levels after surgery and decreased blood leukocyte count more in postoperative period.


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