Key result
Perioperative corticosteroids cut cardiovascular disorders ~56% and shorten ICU stays vs placebo post-esophagectomy.
Why the study?
The efficacy and safety of perioperative corticosteroid administration versus placebo for esophageal cancer patients following esophagectomy required updated evaluation.
Does perioperative corticosteroid administration reduce postoperative complications in esophageal cancer patients following scheduled esophagectomy?
Meta-Analysis (n=508)
Does perioperative corticosteroid administration reduce postoperative complications in esophageal cancer patients following scheduled esophagectomy?
Mean Difference: -3.1 (95% CI -5.43–-0.77)
p-value: p=0.009
Perioperative intravenous corticosteroids may reduce cardiovascular and general complications, as well as ICU stay, in patients undergoing esophagectomy for esophageal cancer.
May shorten ICU stay and reduce cardiovascular/general complications after esophagectomy without increasing severe outcomes; extends prior RCT evidence but requires larger trials for mortality.
BACKGROUND: This updated systematic review and meta-analysis aims to evaluate the efficacy and safety of perioperative corticosteroid administration versus placebo for esophageal cancer patients following scheduled esophagectomy. METHODS: We searched databases through June 30, 2023. We included articles on randomized controlled trials (RCTs) comparing perioperative corticosteroid administration with placebo in esophageal cancer patients with esophagectomy. The outcomes were the death rate during hospitalization, length of hospital stay, and short-term complications. Risk ratios (RRs) and corresponding 95% confidence interval (CIs) for each estimated effect size were applied for dichotomous outcomes, and the mean difference (MD) and corresponding 95% CIs for each estimated effect size were applied for continuous outcomes. We used GRADE to evaluate the quality of each of the outcome and the level of recommendations. RESULTS: Nine RCTs with 508 participants were included in this study. Severe outcomes, including the length of hospital stay, leakage, mortality during the hospitalization period in the corticosteroid group was comparable to that in the control group, but positive effects of corticosteroid administration were observed on the length of intensive care unit stay (MD -3.1, 95% CI - 5.43 to - 0.77), cardiovascular disorders (RR 0.44, 95% CI 0.21-0.94) and other general complications (RR 0.49, 95% CI 0.29-0.85). CONCLUSIONS: Peri-operative intravenous corticosteroid administration may reduce cardiovascular disorders, other general complications and the length of ICU stay without carrying severe outcomes. More high quality RCTs are warranted to further investigate the effects of corticosteroids on postoperative mortality and complications for esophageal cancer patients with esophagectomy. SYSTEMATIC REVIEW REGISTRATION: Cochrane, registration number: 196.
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Zou et al. (2024) conducted a meta-analysis in Esophageal cancer (n=508). Perioperative corticosteroids vs. Placebo or no treatment was evaluated on Length of intensive care unit stay (MD -3.1, 95% CI -5.43 to -0.77, p=0.009). Perioperative corticosteroid administration significantly reduced the length of intensive care unit stay (MD -3.1) and cardiovascular disorders (RR 0.44) compared to placebo in esophageal cancer patients following esophagectomy.
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