Peri-operative glucocorticosteroids decrease complication risk after major pancreatic resection

Perioperative glucocorticoids have the potential to increase the risk of tumor metastasis. Gluococorticosteroids are commonly used in anesthetic practice for prophylaxis against postoperative nausea and vomiting, and they can also be used to prevent allergies before transfusion. Despite their widespread use, few clinical studies have evaluated the effects of perioperative glucocorticosteroids on oncological outcomes, and the results obtained are conflicting

A systematic review recently conducted at the Department of Surgery, The Queen Elizabeth Hospital, South Africa revealed that there could be a possible positive association between glucocorticosteroid and outcomes following major pancreatic resection.

The research is published in the Hepato Pancreato Biliary Journal.

Preliminary evidence suggests perioperative usage may decrease postoperative complications. These positive associations have been observed in a range of different surgeries from intra-abdominal procedures, thoracic, cardiac and orthopaedic surgery.

However, Li Lian Kuan and colleagues aimed to investigate the impact of peri-operative glucocorticosteroid on major pancreatic resection. According to the literature, this is the first systematic review conducted to investigate the significance of peri-operative glucocorticosteroid in patients undergoing pancreatic resections.

The authors carried out a systematic review of a total of five studies. The studies were then analysed. Out of the five papers included, three were randomised control trials and two retrospective cohort studies.

The total patient population was 536. The glucocorticosteroids used were intravenous hydrocortisone or dexamethasone. The study revealed that four studies reported a statistically significant lower morbidity in the peri-operative glucocorticosteroid group. The number needed to treat to prevent one major complication with hydrocortisone was four patients. Furthermore, two studies demonstrated dexamethasone was associated with significantly improved median overall survival.

As a result, the authors concluded that this review shows a possible positive association between glucocorticosteroid and outcomes following major pancreatic resection. However, more randomised control trials are required to confirm if this is a true effect, they further inferred.

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https://doi.org/10.1016/j.hpb.2021.07.001