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Impact of Intraoperative Dexamethasone on Surgical and Oncologic Outcomes for Patients with Resected Pancreatic Ductal Adenocarcinoma

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Administration of dexamethasone to mitigate postoperative nausea and vomiting has been suggested to improve short- and long-term outcomes after pancreatic ductal adenocarcinoma (PDAC) resection. This study aimed primarily to evaluate these hypotheses in a contemporary patient cohort treated with multimodality therapy.

Methods

The clinicopathologic and perioperative characteristics of consecutive resected PDAC patients (July 2011 to October 2018) were analyzed from a prospectively maintained database. Intraoperative administration of dexamethasone (4–10 mg) was retrospectively abstracted from the electronic medical record.

Results

The majority of 373 patients (59.8%) received intraoperative dexamethasone. Most of these patients underwent neoadjuvant therapy (75.3%), were potentially resectable at presentation (69.7%), and underwent pancreaticoduodenectomy (79.9%). Women were more likely to receive dexamethasone than men (69.9 vs 30.1%; p < 0.001). The cohorts were otherwise clinically similar. Intraoperative dexamethasone was not associated with differences in postoperative major complications (PMCs) (21.1 vs 19.3%; p = 0.68), postoperative pancreatic fistulas (6.3 vs 6.7%; p = 0.88), or composite infectious complications (28.7 vs 24.7%; p = 0.39). Dexamethasone was not associated with any improvement in median recurrence-free survival (RFS) (17 vs 17 months; p = 0.99) or overall survival (OS) (46 vs 43 months; p = 0.90). After adjustment for clinical factors including margin status, clinical classification, tumor size, and dexamethasone, the only factors independently associated with OS were pathologic node-positivity (hazard ratio [HR], 1.80, 95% confidence interval [CI], 1.32–2.47), perineural invasion (HR, 2.02; 95% CI, 1.23–3.31), multimodality therapy (HR, 0.30; 95% CI, 0.13–0.70), and PMCs (HR, 1.64; 95% CI, 1.17–2.29) (all p < 0.006).

Conclusions

Dexamethasone failed to demonstrate any protective advantage in terms of mitigating short-term PMCs or infectious complications, or to confer any long-term survival benefit. Tumor biology, multimodality therapy, and PMCs remain the main prognostic factors after PDAC resection.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Timothy E. Newhook MD, Laura R. Prakash MD, Naruhiko Ikoma MD, MS, Michael P. Kim MD, Jeffrey E. Lee MD, Matthew H. G. Katz MD & Ching-Wei D. Tzeng MD

  2. Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jose M. Soliz MD, Shannon Hancher-Hodges MD, Barbra Bryce Speer DO & Jonathan A. Wilks MD

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  1. Timothy E. Newhook MD
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  2. Jose M. Soliz MD
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  3. Laura R. Prakash MD
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  4. Shannon Hancher-Hodges MD
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  8. Michael P. Kim MD
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Correspondence to Ching-Wei D. Tzeng MD.

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Newhook, T.E., Soliz, J.M., Prakash, L.R. et al. Impact of Intraoperative Dexamethasone on Surgical and Oncologic Outcomes for Patients with Resected Pancreatic Ductal Adenocarcinoma. Ann Surg Oncol 28, 1563–1569 (2021). https://doi.org/10.1245/s10434-020-09013-4

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  • DOI: https://doi.org/10.1245/s10434-020-09013-4

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