Clinical benefits of steroid therapy on surgical stress in patients with esophageal cancer

Shimada, Hideaki; Ochiai, Takenori; Okazumi, Shinichi; Matsubara, Hisahiro; Nabeya, Yoshihiro; Miyazawa, Yasumasa; Arima, Miwako; Funami, Yutaka; Hayashi, Hideki; Takeda, Akihiko; Gunji, Yoshio; Suzuki, Takao; Kobayashi, Susumu

doi:10.1067/msy.2000.108614

Cited by 85 publications

(89 citation statements)

References 25 publications

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“…These observations are in line with the studies reporting up to 5 to 15-fold increased blood cortisol levels of critically ill-patients, such as patients with septic shock or massive bleeding (Uete et al, 1970;Sandberg et al, 1956;Jurney et al, 1987;Schroeder et al, 2001;Lamberts et al, 1997;Aygen et al, 1997). Since a positive correlation was observed between the degree of elevation of endogenous cortisol levels and the survival rate in critical disease conditions, the strong increase in endogenous cortisol is presumed to be a protective reflex of the organism against a fatal threat (Schroeder et al, 2001;Lamberts et al, 1997;Aygen et al, 1997;Reincke et al, 1993;Garcia Garcia et al, 2001;Shimada et al, 2000;Bollaert et al, 1998). High-dose glucocorticoids are, therefore, often used as supportive medication for critically ill patients in intensive care units (Shimada et al, 2000;Bollaert et al, 1998).…”

Section: Introductionsupporting

confidence: 79%

“…Since a positive correlation was observed between the degree of elevation of endogenous cortisol levels and the survival rate in critical disease conditions, the strong increase in endogenous cortisol is presumed to be a protective reflex of the organism against a fatal threat (Schroeder et al, 2001;Lamberts et al, 1997;Aygen et al, 1997;Reincke et al, 1993;Garcia Garcia et al, 2001;Shimada et al, 2000;Bollaert et al, 1998). High-dose glucocorticoids are, therefore, often used as supportive medication for critically ill patients in intensive care units (Shimada et al, 2000;Bollaert et al, 1998). It is not clear at present whether the drive behind this rise in endogenous cortisol is the psychological stress of the life-threatening condition or the physical stress that the organism experiences due to deterioration of biological functions.…”

Section: Introductionmentioning

confidence: 99%

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Stress of Dying is not Suppressed by High-dose Morphine or by Dementia

Erkut

Klooker

Endert

et al. 2003

Neuropsychopharmacol

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Hypothalamo-pituitary-adrenal (HPA)-axis activation is a response of the organism to psychological and physical stress, resulting in elevated levels of glucocorticoids, mainly cortisol in humans. In our previous studies we found post-mortem blood and cerebrospinal fluid (CSF) cortisol levels to be up to 20-fold higher than in vivo levels. Since clinical observations point to similar strong elevations of cortisol in fatally ill patients, we suggested that the high post-mortem cortisol levels might be due to the stress during the process of dying. We hypothesized that if the cortisol rise during dying is due to the psychological stress of the impending death, then the rise in cortisol should be inversely proportional to the degree of dementia, and that high-dose morphine giving analgesia, sedation, and sleep would suppress this response. Therefore, we measured the cortisol levels by radioimmunoassay (RIA) in the post-mortem CSF of 85 Alzheimer patients and 52 controls. In addition, post-mortem serum cortisol of 17 subjects from the Alzheimer group and nine from the control group were measured. The Alzheimer patients were subdivided according to their degree of dementia, as scored on the Reisberg Scale, before their death. All groups were further analyzed for the effect of morphine treatment, as well as for the effects of the confounding factors like age, gender, time, and season of death. Alzheimer patients had significantly higher cortisol levels than controls, both in CSF (mean (nmol/ l) 7 SEM: 482 7 32 vs 285 7 30, respectively, po0.001) and in serum (2854 7 279 vs 1533 7 395, p ¼ 0.011). Mean CSF cortisol level of the severely demented Alzheimer group was even significantly higher than that of mildly demented group (508 7 35 vs 225 7 65, p ¼ 0.024) and controls (po0.001). Cortisol levels correlated positively with the degree of dementia in the Alzheimer group (r ¼ 0.236, p ¼ 0.035). High-dose morphine did not cause a suppression of cortisol rise, neither in controls nor in Alzheimer patients. Our results indicate that the extreme elevations of cortisol levels during dying are rather due to the organic stress of the organism than to psychological stress of the patient, and is not suppressed by high-dose morphine.

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Section: Introductionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Stress of Dying is not Suppressed by High-dose Morphine or by Dementia

Erkut

Klooker

Endert

et al. 2003

Neuropsychopharmacol

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“…Following this working hypothesis, perioperative steroid therapy has been evaluated in patients who had undergone esophagectomy. Perioperative steroid therapy reduces postoperative morbidity but does not improve long‐term survival in patients with thoracic esophageal cancer 15, 16, 74. Early administration of sivelestat in patients receiving radical surgery for esophageal cancer can inhibit postoperative systemic inflammatory reactions, and it might also have a beneficial effect on prognosis 75, 76.…”

Section: Resultsmentioning

confidence: 99%

“…Acute lung injury induced by the overproduction of inflammatory cytokines can lead to pneumonia after esophageal surgery 15, 16. For the improvement of long‐term survival, it is essential to minimize mortality by optimizing surgical techniques and perioperative care 17, 18, 19.…”

Section: Introductionmentioning

confidence: 99%

Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature

Shimada

Fukagawa

Haga

et al. 2017

Annals of Gastroent Surgery

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PurposeThe impact of postoperative complications on survival after radical surgery for esophageal, gastric, and colorectal cancers remains controversial. We conducted a systematic review of recent publications to examine the effect of postoperative complications on oncological outcome.MethodsA literature search of PubMed/MEDLINE was performed using the keywords “esophageal cancer,” “gastric cancer,” and “colorectal cancer,” obtaining 27 reports published online up until the end of April 2016. Articles focusing on (i) postoperative morbidity and oncological outcome; and (ii) body mass index (BMI), postoperative morbidity, and oncological outcome, were selected. Univariate and multivariate analyses (Cox proportional hazards model) were performed.ResultsPatients with postoperative complications had significantly poorer long‐term survival than those without complications. Complications were associated with impaired oncological outcomes. The hazard ratios for overall survival were 1.67 (95% confidence interval [CI], 1.31‐2.12), 1.59 (95% CI, 1.13‐2.24), and 1.55 (95% CI, 1.28‐1.87) in esophageal, gastric, and colorectal cancers, respectively. High BMI was associated with postoperative morbidity rate but not with poor oncological outcome. Low BMI was significantly associated with inferior oncological outcome.ConclusionsComplications after radical surgery for esophageal, gastric, and colorectal cancers are associated with patient prognosis. Avoiding such complications might improve the outcomes.

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“…Although a preoperative steroid pulse has been shown to improve the postoperative clinical course after oesophageal cancer operations 25 , a recent prospective study in patients undergoing liver surgery did not demonstrate any improvement in the postoperative clinical course with steroids 10 . In the current study, the incidence of postoperative complications was similar in the two groups.…”

Section: Discussionmentioning

confidence: 97%

Prospective randomized study of steroids in the preventionof ischaemic injury during hepatic resection with pedicle clamping

Muratore

Ribero

Ferrero

et al. 2003

British Journal of Surgery

114

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Background:The major drawback of hepatic pedicle clamping is ischaemia-reperfusion injury with impairment of liver function. Perioperative steroid administration has been advocated to reduce liver damage. The aim of this prospective, randomized study was to determine whether steroid administration can reduce liver injury and improve short-term outcome.Methods: Fifty-three patients undergoing liver resection were randomized to a steroid group (group 1) or to a control group (group 2); patients in group 1 received methylprednisolone 30 mg/kg 30 min before liver resection whereas those in group 2 did not. Serum levels of interleukin (IL) 6, total bilirubin, aspartate aminotransferase (AST) and alanine aminotransferase (ALT), and prothrombin time (PT) were measured. Length of stay, and type and number of complications were recorded.Results: Serum IL-6 levels were significantly lower in the steroid group than in the control group 24 h after surgery. Steroid administration significantly modified AST, ALT and PT levels only in patients with chronic liver disease. Overall and lung-related morbidity were not significantly different between the two groups.Conclusions: Steroid administration suppresses serum IL-6 levels, but has no effect on shortterm outcome.

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Clinical benefits of steroid therapy on surgical stress in patients with esophageal cancer

Cited by 85 publications

References 25 publications

Stress of Dying is not Suppressed by High-dose Morphine or by Dementia

Stress of Dying is not Suppressed by High-dose Morphine or by Dementia

Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature

Prospective randomized study of steroids in the preventionof ischaemic injury during hepatic resection with pedicle clamping

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