Effect of steroid therapy on postoperative course and survival of patients with thoracic esophageal carcinoma

Background

Perioperative steroid therapy has been shown to be safe and effective in inhibiting the production of inflammatory mediators and reducing postoperative hospital morbidity. However, there is limited information to show the effect of steroid therapy on long-term survival. In this study we evaluated the effect of perioperative steroid therapy on long-term survival of patients with thoracic esophageal cancer.

Methods

Between 1993 and 2000, 141 consecutive patients with primary thoracic esophageal cancer underwent radical esophagectomy. A total of 78 patients who underwent surgery between 1997 and 2000 received perioperative steroid therapy. Sixty-three patients who underwent surgery between 1993 and 1996 were analyzed as the control group. In the steroid group, 250 mg methylprednisolone was administered intravenously just before surgery followed by 125 mg on postoperative days 1 and 2. The postoperative course and overall cause-specific survival rates were compared between the groups.

Results

The postoperative hospital morbidity rate was significantly lower in the steroid group than in the control group. Although overall survival of the steroid group was better than the control group, cause-specific survival of both groups was similar. Multivariate analysis suggested that the depth of tumor and postoperative hospital morbidity were significant independent prognostic factors; however, steroid therapy was not statistically significant after adjusting for pathological variables.

Conclusions

Perioperative steroid therapy may improve the postoperative course but does not improve the long-term survival of patients with thoracic esophageal cancer.