Preoperative High-Dose Corticosteroids in Digestive Cancer Surgery: A Randomized Clinical Trial.
Pablo Ortega-Deballon, Abderrahmane Bourredjem, Jean-Marc Régimbeau et al.
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In 30 seconds
This multicenter, double-blind, placebo-controlled superiority randomized trial assessed whether preoperative high-dose corticosteroids improve outcomes after elective, curative-intent surgery for digestive cancer. Patients received intravenous methylprednisolone (20 mg/kg) at anesthesia or placebo. Among 1188 patients with 30-day follow-up, major postoperative complications occurred in 139 of 594 (23%) in the methylprednisolone group and 119 of 594 (20%) in the placebo group (P = .16). Secondary outcomes, including infections, wound healing, and length of stay, also did not differ significantly. The trial found no postoperative benefit from this corticosteroid regimen.
Key findings
- Major postoperative complications occurred in 139 of 594 (23%) with methylprednisolone versus 119 of 594 (20%) with placebo (P = .16).
- Postoperative infections occurred in 182 of 594 (31%) versus 177 of 594 (30%) (P = .75).
- Mean hospital stay was 13.21 [8.59] days with methylprednisolone and 12.97 [8.1] days with placebo (P = .93).
Why it matters
Perioperative inflammation is a proposed target for reducing complications after major digestive surgery, but this randomized trial found no improvement in measured postoperative outcomes with a preoperative corticosteroid pulse. The findings help clarify the evidence for this strategy in elective digestive cancer surgery and caution against assuming that suppressing inflammation translates into better recovery.
What to keep in mind
Follow-up for the reported outcomes was limited to 30 days, and the findings apply to elective curative-intent digestive cancer surgery rather than all surgical settings.