Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2021 Mar;28(3):1563-1569. doi: 10.1245/s10434-020-09013-4. Epub 2020 Aug 16.
Administration of dexamethasone to mitigate postoperative nausea and vomiting has been suggested to improve short- and long-term outcomes after pancreatic ductal adenocarcinoma (PDAC) resection. This study aimed primarily to evaluate these hypotheses in a contemporary patient cohort treated with multimodality therapy.
The clinicopathologic and perioperative characteristics of consecutive resected PDAC patients (July 2011 to October 2018) were analyzed from a prospectively maintained database. Intraoperative administration of dexamethasone (4-10 mg) was retrospectively abstracted from the electronic medical record.
The majority of 373 patients (59.8%) received intraoperative dexamethasone. Most of these patients underwent neoadjuvant therapy (75.3%), were potentially resectable at presentation (69.7%), and underwent pancreaticoduodenectomy (79.9%). Women were more likely to receive dexamethasone than men (69.9 vs 30.1%; p < 0.001). The cohorts were otherwise clinically similar. Intraoperative dexamethasone was not associated with differences in postoperative major complications (PMCs) (21.1 vs 19.3%; p = 0.68), postoperative pancreatic fistulas (6.3 vs 6.7%; p = 0.88), or composite infectious complications (28.7 vs 24.7%; p = 0.39). Dexamethasone was not associated with any improvement in median recurrence-free survival (RFS) (17 vs 17 months; p = 0.99) or overall survival (OS) (46 vs 43 months; p = 0.90). After adjustment for clinical factors including margin status, clinical classification, tumor size, and dexamethasone, the only factors independently associated with OS were pathologic node-positivity (hazard ratio [HR], 1.80, 95% confidence interval [CI], 1.32-2.47), perineural invasion (HR, 2.02; 95% CI, 1.23-3.31), multimodality therapy (HR, 0.30; 95% CI, 0.13-0.70), and PMCs (HR, 1.64; 95% CI, 1.17-2.29) (all p < 0.006).
Dexamethasone failed to demonstrate any protective advantage in terms of mitigating short-term PMCs or infectious complications, or to confer any long-term survival benefit. Tumor biology, multimodality therapy, and PMCs remain the main prognostic factors after PDAC resection.
在接受胰腺导管腺癌 (PDAC) 切除术的患者中，使用地塞米松减轻术后恶心和呕吐的治疗已被建议改善短期和长期预后。本研究旨在通过接受多模式治疗的当代患者队列来评估这些假设。
从前瞻性维护的数据库中分析了连续接受 PDAC 切除术的患者（2011 年 7 月至 2018 年 10 月）的临床病理和围手术期特征。从电子病历中回顾性提取术中地塞米松（4-10mg）的使用情况。
373 例患者（59.8%）中大多数接受了术中地塞米松。这些患者大多接受了新辅助治疗（75.3%），在就诊时具有潜在可切除性（69.7%），并接受了胰十二指肠切除术（79.9%）。女性比男性更有可能接受地塞米松（69.9%比 30.1%；p<0.001）。两组患者在其他方面临床特征相似。术中地塞米松与术后主要并发症（PMCs）（21.1%比 19.3%；p=0.68）、术后胰瘘（6.3%比 6.7%；p=0.88）或复合感染性并发症（28.7%比 24.7%；p=0.39）无差异。地塞米松与中位无复发生存期（RFS）（17 比 17 个月；p=0.99）或总生存期（OS）（46 比 43 个月；p=0.90）的任何改善均无关。在校正包括边缘状态、临床分类、肿瘤大小和地塞米松在内的临床因素后，唯一与 OS 相关的因素是病理淋巴结阳性（HR，1.80，95%置信区间 [CI]，1.32-2.47）、神经周围侵犯（HR，2.02；95%CI，1.23-3.31）、多模式治疗（HR，0.30；95%CI，0.13-0.70）和 PMCs（HR，1.64；95%CI，1.17-2.29）（均 p<0.006）。
地塞米松在减轻短期 PMCs 或感染性并发症方面没有显示出任何保护优势，也没有带来任何长期生存获益。肿瘤生物学、多模式治疗和 PMCs 仍然是 PDAC 切除术后的主要预后因素。
