Effect of preoperative methylpredonisolone infusion on stress response in patients undergoing esophageal cancer surgery

We conducted a study to investigate if methylpredonisolone (MP) could modify the cytokine response and immunity and to determine whether premedication with MP helps to ameliorate postoperative organ disfunction after esophageal cancer surgery. Twenty patients were randomized preoperatively into two equal groups. 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). The peak postoperative plasma level of IL-6 and IL-8 were significantly lower in the MP group than in the control group (p< 0.05). Peripheral blood neutrophil counts were significantly higher in the MP group in the early postoperative period, and administration of MP resulted in a lower plasma polymorphonuclear leukocyte elastase level. These results suggest that migration or adhesion of activated neutrophils was less intense in the MP group. No differences were noted between the groups with respect to variances in immunogloblin fractions, M-CSF, and natural killer cell activity. Postoperative changes in serum bilirubin, the N-acetyl-β-D-glucosaminidase index, and the respiratory index were lower in the MP group (p<0.05). Postoperative complications, such as infection or anastomotic insufficiency, did not occur in either group. Based on these findings, the 10 mg/kg injection of MP prior to esophageal cancer surgery did not greatly affect postoperative wound healing or immunity. The postoperative course of the MP group was satisfactory, and this was believed to be attributable to improvement of tissue injury induced by excessive proinflammatory cytokine-release.