• Yuki Hirano, Takaaki Konishi, Hidehiro Kaneko, Hidetaka Itoh, Satoru Matsuda, Hirofumi Kawakubo, Kazuaki Uda, Hiroki Matsui, Kiyohide Fushimi, Hiroyuki Daiko, Osamu Itano, Hideo Yasunaga, and Yuko Kitagawa.
• Department of Hepatobiliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan.
• Ann. Surg. 2023 Jun 1; 277 (6): e1247e1253e1247-e1253.

ObjectiveTo assess the effect of preoperative prophylactic corticosteroid use on short-term outcomes after oncologic esophagectomy.BackgroundPrevious studies have shown that prophylactic corticosteroid use may decrease the risk of respiratory failure following esophagectomy by attenuating the perioperative systemic inflammation response. However, its effectiveness has been controversial, and its impact on mortality remains unknown.MethodsData of patients who underwent oncologic esophagectomy between July 2010 and March 2019 were extracted from a Japanese nationwide inpatient database. Stabilized inverse probability of treatment weighting, propensity score matching, and instrumental variable analyses were performed to investigate the associations between prophylactic corticosteroid use and short-term outcomes, such as in-hospital mortality and respiratory failure, adjusting for potential confounders.ResultsAmong 35,501 eligible patients, prophylactic corticosteroids were used in 22,620 (63.7%) patients. In-hospital mortality, respiratory failure, and severe respiratory failure occurred in 924 (2.6%), 5440 (15.3%), and 2861 (8.1%) patients, respectively. In stabilized inverse probability of treatment weighting analyses, corticosteroids were significantly associated with decreased in-hospital mortality [odds ratio (OR)=0.80; 95% confidence interval (CI): 0.69-0.93], respiratory failure (OR=0.84; 95% CI: 0.79-0.90), and severe respiratory failure (OR=0.87; 95% CI: 0.80-0.95). Corticosteroids were also associated with decreased postoperative length of stay and total hospitalization costs. The proportion of anastomotic leakage did not differ with the use of Propensity score matching and instrumental variable analysis demonstrated similar results.ConclusionsProphylactic corticosteroid use in oncologic esophagectomy was associated with lower in-hospital mortality as well as decreased respiratory failure and severe respiratory failure, suggesting a potential benefit for preoperative corticosteroid use in esophagectomy.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

25 keywords...

hide…