Effect of preoperative methylprednisolone administration on coagulation and fibrinolytic status in patients undergoing esophageal cancer surgery

We often experience a hypercoagulable state after esophageal cancer surgery, and it is well known that this state is related to development of postoperative complications and organ dysfunction. To investigate if preoperative infusion of methylprednisolone (MP) could modify the disorders in coagulation and fibrinolytic status, we randomized 20 thoracic esophageal cancer patients to two equal groups preoperatively. One group received an infusion of MP (10 mg/kg) 30 minutes prior to the induction of anesthesia (MP group) and the other received a placebo infusion (control group, C group). In the C group, prolongation of activated partial thrombin time (APTT) and decreases in platelet, antithrombin III (AT-III), and plasminogen (Plg) levels were observed postoperatively. In the MP group, prolongation of APTT was shorter, and the lowest levels of AT-III and Plg were higher than in the C group (p<0.05). Postoperative changes in interleukin 6, C-reactive protein and urinary N-acetyl-β-D-glucosaminidase were less in the MP group (p<0.05). The durations of intratracheal intubation and SIRS were also shortened in the MP group. These findings suggest that we could control the postoperative hypercoagulable state and relieve surgical stress and postoperative organ injury by preoperative infusion of MP.