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Preoperative High-Dose Corticosteroids in Digestive Cancer Surgery

JAMA Surgery·August 19
SurgeryPractice changingDigestive CancerPostoperative ComplicationsRandomized Controlled TrialCorticosteroidAdultMethylprednisolone

Summary

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What was studied

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.

Key findings

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.

Study limitations

- 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.

Clinical implications

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.

Related Questions

Explore related topics

What is the evidence for perioperative corticosteroids in colorectal cancer surgery?Which interventions reduce major complications after major abdominal oncologic surgery?Does preoperative anti-inflammatory therapy improve outcomes in gastrointestinal surgery?

Publication Details

Year
2026
Journal
JAMA Surgery
Sample Size
n=1,210
Source
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