This double-blind, placebo-controlled RCT (23 French centers, 2019–2023) assessed whether a single preoperative pulse of IV methylprednisolone (20 mg/kg at anesthesia induction) reduced major postoperative complications within 30 days in adults undergoing elective, curative-intent digestive cancer surgery.
No significant benefit was found: major complications occurred in 23% (139/594) of the methylprednisolone group vs 20% (119/594) of placebo (P = .16). All secondary outcomes — postoperative infections (31% vs 30%), intra-abdominal infections (24% vs 21%), unsatisfactory wound healing (15% vs 12%), and mean hospital stay (~13.2 vs ~13.0 days) — were also non-significant.
- Trial excluded patients undergoing hepatic surgery without digestive anastomosis, limiting generalizability to all digestive cancer operations. - Only French academic/reference centers participated, which may not reflect community practice outcomes. - A small number of patients (22 of 1210) were lost to follow-up, though this is unlikely to change conclusions.
Do not routinely add a preoperative high-dose corticosteroid pulse to reduce complications in elective digestive cancer surgery — it provides no measurable benefit over placebo. This practice should be abandoned in this setting.
