Overview
Perioperative inflammation is harmful in cancer patients, namely in those undergoing surgery: it increases the risk of recurrence, decreases cancer survival, increases post-operative complications, and prolongs the time of recovery and the duration of hospital stay. Severe postoperative complications are also a risk factor of poor survival in cancer patients. Seemingly, some effective therapies currently used to improve the surgical outcome (e.g. immunonutrition, enhanced-recovery protocols) have an inflammatory effect. The modulation of perioperative inflammation therefore seems crucial to improve outcomes in patients undergoing surgery for digestive cancer.
A short perioperative treatment with high doses of corticosteroids has already been tested in several randomized trials. A recent meta-analysis showed that perioperative corticosteroids decreased inflammatory markers and might be associated with fewer complications in esophageal, liver, pancreatic and colorectal surgery: the decrease in the risk of postoperative complications was around 50% without adverse effects.
Eligibility
Inclusion Criteria:
- Age >_18 years
- Elective surgery for any digestive cancer (except purely hepatic surgery)
- Patients operated in a curative intent
- Patients who had given their written informed consent
- Patients affiliated to a National health insurance scheme
Exclusion Criteria:
- Emergency surgery
- Pregnant or breastfeeding women
- Patients with an ongoing oral treatment by steroids
- Palliative surgery
- Exclusive liver surgery
- Concomitant hyperthermic intraperitoneal chemotherapy
- Patient with at least one contra-indication to methylprednisolone treatment :
- active infection
- progressive/symptomatic viral infection (particularly hepatitis, herpes, chickenpox, herpes zoster)
- uncontrolled psychotic state
- hypersensitivity to methylprednisolone or to one of its excipients
- ASA grade >3
- Persons subject to a measure of legal protection (guardianship, tutorship)
- Persons subject to a court order
- Impossibility to adhere to the medical follow-up of the trial for geographical, social or psychological reasons