Control of the Excessive Reaction after Surgery for Esophageal Carcinoma with Preoperative Administration of the Cortico-steroids

Junzo Sayama, Ryuzaburo Shineha, Ken-ichi Yokota, Katsu Hirayama, Norio Higuchi, Hirofumi Ohe, Tatsuya Nakano, Gou Miyata, Kou Sugawara, Harumasa Ueda, Tetsuro Nishihira, Shozo Mori

The Second Department of Surgery, Tohoku University School of Medicine

Corticosteroid (methylprednisolone 250 mg/body) was preoperatively administered to patients with esophageal carcinoma in order to control the excessive reaction induced by surgical stress, and the steroid group (n=8) was compared with a control group (n=9) as to clinical course, changes in plasma cytokine levels and other factors. Body weight and water balance recovered earlier in the steroid group, although there were no differences in changes in cardiac index, mean pulmonary arterial pressure and pulmonary capillary wedge pressure between the two groups. In the steroid group, heart rate remained within the normal range and the number of cases with postoperative arrhythmia tended to decrease. Postoperative plasma IL-6 and G-CSF reached a very high level in the control group, but production of cytokines, especially IL-6, in the steroid group was significantly inhibited and urinary excretion of catecholamines also decreased in the steroid group. Side effects of steroid like abnormality in glucose tolerance, infection and delay in wound healing did not appear, and decrease in peripheral lymphocyte count due to surgical stress was reduced in the steroid group. These results suggest that preoperative administration of steroid reduced the postoperative excessive reaction mainly in the circulation induced by surgical stress, and is very useful for postoperative management of the patients.

Key words
preoperative administration of steroid (methylprednisolone), surgery for esophageal carcinoma, control of postoperative reaction, inhibition of production of IL-6 and G-CSF

Reprint requests
Junzo Sayama The Second Department of Surgery, Tohoku University School of Medicine
1-1 Seiryomachi, Aobaku, Sendai, 980 JAPAN

Accepted
December 8, 1993

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