Short-term and Long-term Outcomes of Prophylactic Corticosteroid in Esophageal Cancer Surgery: A Multicenter Retrospective Study

Background/Aim: The incidence of postoperative infections after esophagectomy is relatively high and may adversely affect cancer survival. The aim of the study was to investigate the effect of prophylactic corticosteroid administration on short-term and long-term outcomes after esophagectomy. Patients and Methods: The Clinical Trial Committee of the Japan Society for Surgical Infection conducted this multicenter retrospective cohort study involving 407 patients with pStage I/II/III esophageal cancer at 11 Centers between April 2013 and March 2015. The patients were divided into the With Steroid group (n=287) and Without Steroid group (n=120), and 94 matched pairs were created using 1:1 propensity score matching for comparison. The median follow-up period was 51.7 months. Results: Background characteristics were balanced after matching. Methylprednisolone was administered in 79.8% of cases (single preoperative dose for all patients). The incidences of overall surgical site infection (SSI) (17.0% vs. 30.9%, p=0.040), incisional SSI, and organ/space SSI, including anastomotic leakage (10.6% vs. 28.7%, p=0.003), were significantly lower in the With Steroid group. The 5-year relapse-free survival rates were 59.3% in the With Steroid group and 43.6% in the Without Steroid group, while the 5-year overall survival rates were 64.6% and 51.9%, respectively. Although the 5-year relapse-free and overall survival rates were numerically higher in the With Steroid group compared to the Without Steroid group, the differences were not statistically significant (p=0.051 and p=0.074, respectively). Conclusion: Prophylactic corticosteroid administration was associated with a reduction in SSI, including anastomotic leakage, and a potential benefit for long-term survival after esophagectomy for esophageal cancer. Larger prospective trials are warranted to confirm these findings and further refine perioperative management strategies.