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Annals of Surgical Oncology

, Volume 25, Issue 13, pp 4020–4026 | Cite as

Intraoperative Dexamethasone Decreases Infectious Complications After Pancreaticoduodenectomy and is Associated with Long-Term Survival in Pancreatic Cancer

  • Marta Sandini
  • Katarina J. Ruscic
  • Cristina R. Ferrone
  • Andrew L. Warshaw
  • Motaz Qadan
  • Matthias Eikermann
  • Keith D. Lillemoe
  • Carlos Fernández-del Castillo
Pancreatic Tumors

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Notes

Conflict of interest

All the authors state that there is no conflict of interest.

Supplementary material

10434_2018_6827_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 17 kb)
10434_2018_6827_MOESM2_ESM.pdf (32 kb)
Supplementary material 2 (PDF 31 kb)

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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Marta Sandini
    • 1
  • Katarina J. Ruscic
    • 2
  • Cristina R. Ferrone
    • 1
  • Andrew L. Warshaw
    • 1
  • Motaz Qadan
    • 1
  • Matthias Eikermann
    • 2
  • Keith D. Lillemoe
    • 1
  • Carlos Fernández-del Castillo
    • 1
  1. 1.Department of Surgery, Harvard Medical SchoolMassachusetts General HospitalBostonUSA
  2. 2.Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical SchoolMassachusetts General HospitalBostonUSA

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