Does Preoperative Corticosteroid Administration Improve the Short-Term Outcome of Minimally Invasive Esophagectomy for Esophageal Cancer? A Propensity Score-Matched Analysis.

Abstract

In open esophagectomy for esophageal cancer, steroid administration is associated with attenuated postoperative inflammation and reduced complications. However, the efficacy of steroids in minimally invasive esophagectomy (MIE) is uncertain. This study aimed to investigate the impact of steroid administration on short-term postoperative outcomes in MIE. The study compared 458 patients who underwent MIE between April 2017 and December 2021. The patients were divided into steroid (n = 206) and non-steroid (n = 252) groups, and 160 paired cases were compared by 1:1 propensity score-matching. In the steroid group versus the non-steroid group, the intensive care unit stay was significantly shorter (2.6 vs 3.3 days; P = 0.001), and the incidence of surgical-site infection (SSI) was significantly lower (1.2 % vs 13.1 %; P < 0.001). The incidence of pneumonia tended to be lower in the steroid group, but not significantly lower (19.3 % vs 29.3 %; P = 0.065). Multivariate analysis showed that steroid administration independently affected SSI (odds ratio, 11.6; 95 % confidence interval, 3.3-73.6; P < 0.001). Compared with the non-steroid group, the steroid group had more favorable arterial partial pressure of oxygen/fraction of inspired oxygen ratio (503 ± 178 vs 380 ± 104; P < 0.001) and body temperature (37.2 ± 0.54 °C vs 38.3 ± 0.66 °C; P < 0.001) on postoperative day (POD) 0, heart rate (beats per minute) (74.6 ± 8.9 vs 84 ± 11.4; P < 0.001) on POD 1, and C-reactive protein concentration (7.07 ± 3.4 vs 13.7 ± 6.4 mg/dL; P < 0.001) on POD 3. In MIE, steroid administration was associated with reduced SSI, suggesting an attenuated inflammatory response to surgical stress.