Liu Haonan, Wei Kongyuan, 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):2856-2858. doi: 10.1245/s10434-024-16831-3. Epub 2025 Jan 24.
Pancreatoduodenectomy (PD) is a complex surgery with high morbidity and mortality, often associated with complications like post-pancreatectomy hemorrhage (PPH) and postoperative pancreatic fistulas (POPF). The corticosteroids administered intraoperatively has been shown to improve postoperative outcomes in patients undergoing surgery. However, their impact on complications following PD remains controversial.
A comprehensive review of literature found no significant impact of perioperative corticosteroids on postoperative complications in PD, including postoperative major complications (PMCs), POPF, infectious complications, delayed gastric emptying (DGE), post-pancreatectomy hemorrhage (PPH), bile leakage, reoperation, or 30-days mortality.
Other medications, such as octreotide, antibiotics, and probiotics, have shown potential in reducing complications, but further research is needed, especially for corticosteroids in PD. In the near future, more randomized controlled trials should be conducted, along with well-designed clinical studies, to provide high-level evidence for the potential benefits of corticosteroids in PD for targeted populations.
胰十二指肠切除术(PD)是一种复杂的手术,发病率和死亡率较高,常伴有胰十二指肠切除术后出血(PPH)和术后胰瘘(POPF)等并发症。术中使用皮质类固醇已被证明可改善手术患者的术后结局。然而,它们对PD术后并发症的影响仍存在争议。
对文献的全面综述发现,围手术期皮质类固醇对PD术后并发症没有显著影响,包括术后严重并发症(PMC)、POPF、感染性并发症、胃排空延迟(DGE)、胰十二指肠切除术后出血(PPH)、胆漏、再次手术或30天死亡率。
其他药物,如奥曲肽、抗生素和益生菌,已显示出降低并发症的潜力,但仍需进一步研究,尤其是针对PD中皮质类固醇的研究。在不久的将来,应进行更多的随机对照试验以及精心设计的临床研究,为皮质类固醇对特定人群PD的潜在益处提供高级别证据。