Metanálise sobre o uso de glicocorticóides pré-operatório para redução do risco de complicações após esofagectomia por carcinoma do esôfago

Abstract

RESUMO JUSTIFICATIVA E OBJETIVOS: O emprego de glicocorticóides tem sido proposto para reduzir a morbidade após intervenções cirúrgicas, porém, não é largamente utilizado antes da ressecção do esôfago porque não existem conhecimentos suficientes sobre a sua eficácia. O objetivo do trabalho foi verificar os efeitos da administração pré-operatória de glicocorticóides, em pacientes submetidos à esofagectomia por carcinoma de esôfago. RESULTADOS: Quatro estudos envolvendo 169 pacientes foram localizados. Não ocorreram diferenças na mortalidade pós-operatória e nas incidências de deiscência de anastomose e insuficiências renal e hepática entre glicocorticóides e placebo. Houve decréscimo na incidência de complicações respiratórias pós-operató-rias (95% IC = 0,09-0,46) , sepse (95% IC = 0,10-0,81) e no total de complicações pós-operatórias (95% IC = 0,06-0,23) no grupo tratado com glicocorticóides. CONCLUSÕES: A administração pré-operatória de glicocorticóides foi associada com um decréscimo nas complicações pós-operatórias. Unitermos: esofagectomia, Falência de múltiplos ór-gãos, literatura de revisão, Metanálise, Metilprednisolona. SUMMARY BACKGROUND AND OBJECTIVES:Preoperative glucocorticoid administration has been proposed for reducing postoperative morbidity. This is not widely used before esophageal resection because of incomplete knowledge regarding its effectiveness. The aim here was to assess the effects of preoperative glucocorticoid administration in adults undergoing esophageal resection for esophageal carcinoma. METHODS: studies were identified by searching the Cochrane Controlled Trials Register, MeDlINe, eMBAse, Cancerlit, sCIelO and Cochrane library, and by manual searching from relevant articles. The last search for clinical trials for this systematic review was performed in December 2005. This review included randomized studies of patients with potentially resectable carcinomas of the esophagus that compared preoperative glucocorticoid administration with placebo. Data were extracted by the reviewer, and the trial quality was assessed using Jadad scoring. Odds ratio with 95%

Design and level of evidence of studies published in two Brazilian medical journals recently indexed in the ISI Web of Science database

“…Crosssectional studies and case reports were the most frequent design type in both journals, representing over 50% of all the clinical articles published during that year. Out of the 289 articles published in 2007, four were randomized (or quasi-randomized) trials [9][10][11][12] and four were systematic reviews, [13][14][15][16] thus representing less than 2% of the total number of published papers in both of these journals. After exclusion of six clinical guidelines [17][18][19][20][21][22] and 80 non-evidence articles (technical notes, clinical measurement validation studies, continuing medical education, quizzes and others) the distribution of the remaining 203 articles is presented in Table 2.…”

“…According to the Oxford criteria, 25.6% of the articles were classified as level 4 or 5 evidence, while 2.8% were level 1. Table 3 presents the AMSTAR scores of the four systematic reviews [13][14][15][16] published during 2007 in the two journals. The overall scores ranged from 1 to 6, with a mean score of 4.0 (standard deviation: 2.2).…”

“…To reduce bias and subjectivity, it is recommended that all steps of a systematic review be conducted by two independent investigators. However, one of the published reviews was apparently performed by a single reviewer (the author) 16 and, although the other three reviews had more than one author, 13-15 they did not report whether the study selection and data extraction had been done in duplicate. Similarly, none of the four reviews provided all the necessary details on the literature search, such as the names of the electronic databases, the years and key words used, and whether searches were complemented by consulting current contents, reviews, textbooks, specialized registers or experts in the particular field of study, or by reviewing the references in the studies found.…”

Práticas baseadas em evidências publicadas no Brasil: identificação e reflexão na área da prevenção em saúde humana

“…Thus, there were studies that only focused on the prevalence or incidence of health problem events (I) (12)(13)27,32,45,(47)(48)67,81,(83)(84)(85)(86)90,92) ; others to iden fy and/or associate risk factors (II) ( ; and s ll others to correlate interven ons with preven on, prophylaxis or reduc on of events (III) (14)(15)(17)(18)20,23,33,46,(50)(51)(53)(54)(55)58,62,(64)(65)(68)(69)(70)(71)(72)(73)(74)(75)(76)(79)(80)82,89,91,(93)(94) .…”