Rethinking Perioperative Corticosteroids in Esophageal Cancer Surgery: Evidence From an Integrative Meta-Analysis

Abstract

Background

Esophagectomy remains a highly invasive procedure associated with substantial postoperative morbidity. Pulmonary complications, anastomotic leakage, and in-hospital mortality are of particular concern. Perioperative corticosteroids are often administered to attenuate excessive inflammatory responses; however, the clinical impact in esophageal cancer surgery remains inconclusive, with studies yielding inconsistent findings and lacking integrated long-term evaluation. This meta-analysis aimed to comprehensively assess the effects of perioperative corticosteroid administration on both short-term complications and long-term survival in patients undergoing esophagectomy.

Methods

A systematic literature search identified randomized controlled trials and observational studies published to October 2025 that examined corticosteroid use during esophagectomy. Primary outcomes comprised postoperative pneumonia, anastomotic leakage, and in-hospital mortality. Secondary outcomes comprised respiratory failure, acute respiratory distress syndrome, wound infection, hepatic and renal dysfunction, cardiac complications, and overall survival. Pooled odds ratios (ORs) and hazard ratios were calculated using random-effects models.

Results

Nineteen studies involving 38 316 patients were included. Perioperative corticosteroid use was associated with a significantly lower incidence of pneumonia (OR = 0.71), in-hospital mortality (OR = 0.79), and respiratory failure (OR = 0.30) compared with no corticosteroids. No increase in anastomotic leakage or wound infection rates were observed with versus without perioperative corticosteroids; long-term survival was unaffected (hazard ratio: 0.85), and no excess risk of other complications was detected.

Conclusions

To our knowledge, this is the first meta-analysis integrating both short- and long-term outcomes, suggesting that perioperative corticosteroids may reduce major postoperative complications without evidence of adverse long-term oncologic outcomes; however, these findings were largely driven by observational studies.