Intraoperative dexamethasone after pancreatoduodenectomy in pancreatic ductal adenocarcinoma: A retrospective cohort study.

Abstract

Background and aims: The anti-inflammatory effects of dexamethasone may reduce the inflammatory response after pancreatoduodenectomy. The aim of this retrospective observational study was to evaluate the association between intraoperative dexamethasone and postoperative complications in patients undergoing pancreatoduodenectomy with a special focus on patients with pancreatic ductal adenocarcinoma (PDAC).

Methods: All eligible patients undergoing pancreatoduodenectomy in our hospital between January 2018 and December 2021 (n = 319) were included comparing the postoperative outcomes in patients who received intraoperative dexamethasone (n = 178) to patients not given any intraoperative glucocorticoids (n = 142).

Results: PDAC was the most common diagnosis (n = 166) and of these patients 92 received intraoperative dexamethasone and 74 no glucocorticoids. Patients with PDAC who received dexamethasone experienced fewer severe Clavien-Dindo complications than those not receiving glucocorticoids (n = 13/92 (14.1%) vs n = 21/74 (28.4%), P = 0.033). Multivariable analyses confirmed that a single dose of dexamethasone was associated with a reduced risk of severe complications in this patient group (odds ratio (OR) 0.40, 95% confidence interval [CI] 0.18-0.91, P = 0.030). When considering all pancreatoduodenectomy patients, no statistically significant differences in postoperative complications were observed. The incidence of postoperative infections was similar between the groups, although postoperative C-reactive protein (CRP) levels were lower in pancreatoduodenectomy patients who received dexamethasone (CRP on the second postoperative day: 102 (69-146) vs 159 (112-208) mg/l, P < 0.001). Patients who received dexamethasone experienced postoperative fever less frequently than those not given an intraoperative glucocorticoid (n = 68/178 (38.4%) vs n = 73/141 (51.8%), P = 0.023). Dexamethasone had no statistically significant influence on overall survival of PDAC patients.

Conclusion: A single dose of dexamethasone was not associated with decreased postoperative complications across all pancreatoduodenectomy patients. However, within the PDAC subgroup, there were fewer Clavien-Dindo ⩾ 3 complications after dexamethasone compared to no glucocorticoid administration.