School of Medicine South China University of Technology, Guangzhou, 510006, People's Republic of China.
Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, People's Republic of China.
BMC Surg. 2024 Feb 15;24(1):57. doi: 10.1186/s12893-024-02342-1.
This updated systematic review and meta-analysis aims to evaluate the efficacy and safety of perioperative corticosteroid administration versus placebo for esophageal cancer patients following scheduled esophagectomy.
We searched databases through June 30, 2023. We included articles on randomized controlled trials (RCTs) comparing perioperative corticosteroid administration with placebo in esophageal cancer patients with esophagectomy. The outcomes were the death rate during hospitalization, length of hospital stay, and short-term complications. Risk ratios (RRs) and corresponding 95% confidence interval (CIs) for each estimated effect size were applied for dichotomous outcomes, and the mean difference (MD) and corresponding 95% CIs for each estimated effect size were applied for continuous outcomes. We used GRADE to evaluate the quality of each of the outcome and the level of recommendations.
Nine RCTs with 508 participants were included in this study. Severe outcomes, including the length of hospital stay, leakage, mortality during the hospitalization period in the corticosteroid group was comparable to that in the control group, but positive effects of corticosteroid administration were observed on the length of intensive care unit stay (MD -3.1, 95% CI - 5.43 to - 0.77), cardiovascular disorders (RR 0.44, 95% CI 0.21-0.94) and other general complications (RR 0.49, 95% CI 0.29-0.85).
Peri-operative intravenous corticosteroid administration may reduce cardiovascular disorders, other general complications and the length of ICU stay without carrying severe outcomes. More high quality RCTs are warranted to further investigate the effects of corticosteroids on postoperative mortality and complications for esophageal cancer patients with esophagectomy.
Cochrane, registration number: 196.
本更新的系统评价和荟萃分析旨在评估围手术期给予皮质类固醇与安慰剂相比，对接受择期食管癌切除术的食管癌患者的疗效和安全性。
我们通过 2023 年 6 月 30 日检索数据库。我们纳入了比较围手术期给予皮质类固醇与安慰剂治疗食管癌患者接受食管癌切除术的随机对照试验（RCT）的文章。结局是住院期间死亡率、住院时间和短期并发症。对于二分类结局，应用风险比（RR）及其相应的 95%置信区间（CI）来估计每个效应量；对于连续性结局，应用均数差值（MD）及其相应的 95%CI 来估计每个效应量。我们使用 GRADE 评估每个结局的质量和推荐水平。
本研究纳入了 9 项 RCT，共 508 名参与者。严重结局方面，皮质类固醇组的住院时间、漏液和住院期间死亡率与对照组相当，但皮质类固醇给药具有积极的作用，可缩短重症监护病房（ICU）停留时间（MD-3.1，95%CI-5.43 至-0.77）、心血管疾病（RR 0.44，95%CI 0.21-0.94）和其他一般并发症（RR 0.49，95%CI 0.29-0.85）。
围手术期静脉内给予皮质类固醇可能会减少心血管疾病、其他一般并发症和 ICU 停留时间，而不会增加严重结局。需要更多高质量的 RCT 来进一步研究皮质类固醇对接受食管癌切除术的食管癌患者术后死亡率和并发症的影响。
Cochrane，注册号：196。
