Influence of neutrophil elastase inhibitor on the postoperative course in patients with esophageal cancer after transthoracic esophagectomy.

BACKGROUND/AIMS: We evaluated influence of sivelestat sodium hydrate in the clinical course after transthoracic esophagectomy.

METHODOLOGY: Forty-two consecutive patients with esophageal cancer underwent transthoracic esophagectomy. Twenty-two patients were treated with sivelestat (sivelestat group) and twenty patients were untreated (control group). Sivelestat (0.2 mg/(kg·h)-1) was continuously administered for 5 days since ICU admission. Postoperative morbidity, duration of systemic inflammatory response syndrome (SIRS) and mechanical ventilation, and the time to refilling were examined. The level of serum white blood cells (WBC), C-reactive protein (CRP), aspartate transaminase (AST), alanine aminotransferase (ALT), total bilirubin (TB) and the PaO2/FiO2 ratio were measured.

RESULTS: The durations of SIRS and mechanical ventilation and the time to refilling were significantly shorter in the sivelestat group than in the control group. Postoperative changes in the serum WBC, CRP, AST and ALT levels were not significantly different between the groups; however, serum TB level was significantly lower in the sivelestat group than in the control group. The PaO2/FiO2 ratio at postoperative day 3 was significantly higher in the former than in the latter.

CONCLUSIONS: We demonstrated that sivelestat might contribute to the improvement of acute lung injury, hyperbilirubinemia and postoperative circulatory failure.