TY - JOUR
T1 - Impact of Intraoperative Dexamethasone on Surgical and Oncologic Outcomes for Patients with Resected Pancreatic Ductal Adenocarcinoma
AU - Newhook, Timothy E.
AU - Soliz, Jose M.
AU - Prakash, Laura R.
AU - Hancher-Hodges, Shannon
AU - Speer, Barbra Bryce
AU - Wilks, Jonathan A.
AU - Ikoma, Naruhiko
AU - Kim, Michael P.
AU - Lee, Jeffrey E.
AU - Katz, Matthew H.G.
AU - Tzeng, Ching Wei D.
N1 - Publisher Copyright:
© 2020, Society of Surgical Oncology.
PY - 2021/3
Y1 - 2021/3
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85089509824&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85089509824&partnerID=8YFLogxK
U2 - 10.1245/s10434-020-09013-4
DO - 10.1245/s10434-020-09013-4
M3 - Article
C2 - 32803553
AN - SCOPUS:85089509824
SN - 1068-9265
VL - 28
SP - 1563
EP - 1569
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 3
ER -