Liu Haonan, Wei Kongyuan, Cao Ruiqi, Wu Jiaoxing, Feng Zhengyuan, Wang Fangzhou, Zhou Cancan, Wu Shuai, Han Liang, Wang Zheng, Ma Qingyong, Wu Zheng
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Pancreas Center, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Ann Surg Oncol. 2025 Apr;32(4):2841-2851. doi: 10.1245/s10434-024-16704-9. Epub 2025 Jan 2.
The intraoperative administration of corticosteroids has been shown to improve postoperative outcomes in patients undergoing surgery; however, the impact of corticosteroids on complications following pancreatoduodenectomy (PD) remains controversial.
This study aimed to evaluate the efficacy of perioperative corticosteroids on postoperative complications after PD.
A comprehensive search was conducted using the PubMed, Embase, and Web of Science databases for studies published prior to 1 July 2024. Of 7418 articles identified, a total of 5 studies were eligible for inclusion in this meta-analysis. The primary outcome was incidence of postoperative major complications (PMCs), while the additional outcomes were incidences of postoperative pancreatic fistulas (POPFs), infection, delayed gastric emptying (DGE), post-pancreatectomy hemorrhage (PPH), bile leakage, reoperation, and 30-day mortality. The study was registered in the PROSPERO database (CRD42024524936).
Finally, 5 studies involving 1449 patients (537 with corticosteroids and 912 without corticosteroids) were analyzed. Intraoperative corticosteroids were not associated with any improvement in PMCs (p = 0.41). The incidence of POPF (p = 0.12), infectious complications (p = 0.15), or DGE (p = 0.81) were not significantly different between the two groups. No obvious differences were found in the incidence of PPH (p = 0.42), bile leakage (p = 0.68), 30-day mortality (p = 0.99), or reoperation (p = 0.26).
Perioperative corticosteroids did not significantly demonstrate any protective advantage in terms of postoperative complications after PD. This finding may serve as a reference for the perioperative use of corticosteroids in pancreatic surgery. Well-designed clinical trials are warranted in the near future in order to provide high-level evidence.
术中给予皮质类固醇已被证明可改善手术患者的术后结局；然而，皮质类固醇对胰十二指肠切除术（PD）后并发症的影响仍存在争议。
本研究旨在评估围手术期使用皮质类固醇对PD术后并发症的疗效。
使用PubMed、Embase和Web of Science数据库对2024年7月1日前发表的研究进行全面检索。在识别出的7418篇文章中，共有5项研究符合纳入本荟萃分析的条件。主要结局是术后主要并发症（PMC）的发生率，其他结局包括术后胰瘘（POPF）、感染、胃排空延迟（DGE）、胰十二指肠切除术后出血（PPH）、胆漏、再次手术及30天死亡率的发生率。该研究已在PROSPERO数据库注册（CRD42024524936）。
最终，分析了5项涉及1449例患者的研究（537例使用皮质类固醇，912例未使用皮质类固醇）。术中使用皮质类固醇与PMC的改善无关（p = 0.41）。两组间POPF（p = 0.12）、感染性并发症（p = 0.15）或DGE（p = 0.81）的发生率无显著差异。PPH（p = 0.42）、胆漏（p = 0.68）、30天死亡率（p = 0.99）或再次手术（p = 0.26）的发生率也未发现明显差异。
围手术期使用皮质类固醇在PD术后并发症方面未显示出明显的保护优势。这一发现可为胰腺手术中皮质类固醇的围手术期使用提供参考。近期有必要开展设计良好的临床试验以提供高级别证据。
