Abstract | BACKGROUND: 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.
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Authors | Marta Sandini, Katarina J Ruscic, Cristina R Ferrone, Andrew L Warshaw, Motaz Qadan, Matthias Eikermann, Keith D Lillemoe, Carlos Fernández-Del Castillo |
Journal | Annals of surgical oncology
(Ann Surg Oncol)
Vol. 25
Issue 13
Pg. 4020-4026
(Dec 2018)
ISSN: 1534-4681 [Electronic] United States |
PMID | 30298316
(Publication Type: Journal Article)
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Chemical References |
- Glucocorticoids
- Dexamethasone
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Topics |
- Abdominal Abscess
(etiology)
- Aged
- Carcinoma, Pancreatic Ductal
(surgery)
- Dexamethasone
(therapeutic use)
- Female
- Glucocorticoids
(therapeutic use)
- Humans
- Intraoperative Period
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Pancreatic Fistula
(etiology, microbiology)
- Pancreatic Neoplasms
(surgery)
- Pancreaticoduodenectomy
(adverse effects)
- Pneumonia
(etiology)
- Proportional Hazards Models
- Retrospective Studies
- Sepsis
(etiology)
- Surgical Wound Infection
(etiology)
- Survival Rate
- Time Factors
- Urinary Tract Infections
(etiology)
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