Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
Ann Surg Oncol. 2018 Dec;25(13):4020-4026. doi: 10.1245/s10434-018-6827-5. Epub 2018 Oct 8.
Dexamethasone is administered intraoperatively to prevent anesthesia-related nausea and vomiting and to reduce postoperative opioid administration. However, the adverse effects of corticosteroids on anastomotic healing and wound infection as well as oncologic outcomes remain unclear. We analyzed the effect of intraoperative dexamethasone administration on surgical outcomes after pancreaticoduodenectomy and on long-term survival in pancreatic cancer patients.
A total of 679 pancreaticoduodenectomies from a prospectively maintained database were analyzed. Surgical outcomes were compared between patients who received intraoperative dexamethasone and those who did not. Kaplan-Meier curves and Cox-regression survival analysis were performed in patients with pancreatic cancer. A propensity analysis was done to reduce the inherent bias of retrospective design.
Patients who received dexamethasone (117, 17.2%) were younger and more likely to be female than those who did not (p = 0.001). Overall and 30-day major morbidity were similar among all resected patients, although there were fewer infectious complications in the dexamethasone group (18.8% vs. 28.5%, p = 0.032). In pancreatic cancer patients, dexamethasone was associated with significantly improved median overall survival (46 vs. 22 months, p = 0.017). This effect occurred independently of stage, pathologic characteristics, or adjuvant therapy, with adjusted hazard ratios, derived from pre-propensity and post-propensity analysis, of 0.67 (0.47-0.97) and 0.57 (0.37-0.87), respectively.
A single intraoperative dose of dexamethasone did not increase morbidity after pancreaticoduodenectomy and, in fact, was associated with a decrease in infectious complications. The treatment was independently associated with improved overall survival in patients with pancreatic adenocarcinoma, an effect that cannot be explained and needs further validation in a prospective setting.
地塞米松在术中给药可预防麻醉相关的恶心和呕吐，并减少术后阿片类药物的使用。然而，皮质类固醇对吻合口愈合和伤口感染以及肿瘤学结果的不良影响尚不清楚。我们分析了术中给予地塞米松对胰十二指肠切除术手术结果的影响，以及对胰腺癌患者长期生存的影响。
我们分析了前瞻性维护数据库中的 679 例胰十二指肠切除术。比较了接受术中地塞米松和未接受地塞米松的患者的手术结果。对胰腺癌患者进行 Kaplan-Meier 曲线和 Cox 回归生存分析。进行倾向分析以减少回顾性设计的固有偏差。
接受地塞米松（117 例，17.2%）的患者比未接受地塞米松的患者年龄更小，更可能为女性（p=0.001）。所有接受切除术的患者的总体和 30 天主要发病率相似，但地塞米松组的感染并发症较少（18.8%比 28.5%，p=0.032）。在胰腺癌患者中，地塞米松与显著改善的中位总生存期相关（46 个月比 22 个月，p=0.017）。这种效果独立于分期、病理特征或辅助治疗，来自于预倾向和后倾向分析的调整后的危险比分别为 0.67（0.47-0.97）和 0.57（0.37-0.87）。
单次术中给予地塞米松不会增加胰十二指肠切除术后的发病率，实际上与感染性并发症的减少相关。该治疗与胰腺癌患者的总生存改善独立相关，这种效果不能用其他因素解释，需要在前瞻性研究中进一步验证。
