The Effect of Perioperative Dexamethasone on Postoperative Complications after Pancreaticoduodenectomy

Abstract

Objective: This study aimed to evaluate the effect of perioperative dexamethasone on postoperative complications after pancreaticoduodenectomy. Background: The glucocorticoid dexamethasone has been shown to improve postoperative outcomes in surgical patients, but its effects on postoperative complications after pancreaticoduodenectomy are unclear. Methods: This multicenter, double-blind, randomized controlled trial was conducted in four Chinese high-volume pancreatic centers. Adults undergoing elective pancreaticoduodenectomy were randomized to receive either 0.2 mg/kg dexamethasone or a saline placebo as an intravenous bolus within 5 minutes after anesthesia induction. The primary outcome was the Comprehensive Complication Index (CCI) score within 30 days after the operation, analyzed using the modified intention-to-treat principle. Results: Among 428 patients for eligibility, 300 participants were randomized and 265 were included in the modified intention-to-treat analyses. 134 patients received dexamethasone and 131 patients received a placebo. The mean (SD) CCI score was 14.0 (17.5) in the dexamethasone group and 17.9 (20.3) in the placebo group (mean difference, −3.8; 95% CI, −8.4 to 0.7; P=0.100). The incidence of major complications (Clavien-Dindo grade ≥III) (12.7% vs. 16.0%, risk ratio 0.79; 95% CI, 0.44 to 1.43; P=0.439) and postoperative pancreatic fistula (25.4% vs. 31.3%, risk ratio 0.81; 95% CI, 0.55 to 1.19; P=0.286) were not significantly different between the two groups. In the stratum of participants with a main pancreatic duct ≤3 mm (n=202), the CCI score was significantly lower in the dexamethasone group (mean difference, -6.4; 95% CI, −11.2 to −1.6; P=0.009). Conclusion: Perioperative dexamethasone did not significantly reduce postoperative complications within 30 days after pancreaticoduodenectomy.

Pancreaticoduodenectomy with Pancreaticogastrostomy and an External Pancreatic Stent in Risky Patients without Clinically Relevant PostoperativePancreatic Fistula: A Propensity Score-Matched Analysis

“…Other researches veri ed that PG is associated with much lower POPF than PJ. In high-risk patients, PG can be rendered safer than PJ as regards short-term outcomes [9][10][11][12].…”

“…The PG anastomosis is simple to perform because of the stomach's thick wall, which grips sutures well, its rich blood supply, its proximity to the pancreatic stump, its acidity, which inhibits the pancreatic juice's proteolytic enzymes, the absence of enterokinase in the gastric juice, and the nasogastric tube's ability to maintain negative pressure, all of which help with sound anastomosis [9][10][11][12][13][14]29].…”

“…POPF is the most frequent morbidity after PD ranging from 5-30% and greatly raises hospital stays, sepsis, and death even in high-volume centres. Many variables, including age, liver status, obesity, type of pancreatic-enteric anastomosis, soft friable pancreatic stump, pancreatic duct diameter, pancreatic duct location, intraoperative blood loss, operative duration, immunosuppressive drugs intake, organ transplantation may impact the development of POPF [4][5][6][7][8][9][10].…”

“…Numerous technical modi cations have been made to decline the prevalence and severity of POPF, these include binding pancreaticojejunostomy (PJ), using an isolated Roux loop for PJ, omental wrapping of the anastomosis, use of the duct-to-mucosa technique, placing a pancreatic duct stent either external or internal, reconstructing with pancreaticogastrostomy (PG), pharmacological prevention by administering dexamethasone and somatostatin [9][10][11][12][13][14][15][16][17].…”