Background

There is increasing evidence that peri-operative glucocorticosteroid can ameliorate the systemic response following major surgery. Preliminary evidence suggests peri-operative usage of glucocorticosteroid may decrease post-operative complications. These positive associations have been observed in a range of different operations including intra-abdominal, thoracic, cardiac, and orthopaedic surgery. This review aims to investigate the impact of peri-operative glucocorticosteroid in major pancreatic resections.

Methods

A systematic review based on a search in Medline and Embase databases was performed. PRISMA guidelines for systematic reviews were followed.

Results

A total of five studies were analysed; three randomised controlled trials and two retrospective cohort studies. The total patient population was 1042. The glucocorticosteroids used were intravenous hydrocortisone or dexamethasone. Three studies reported significantly lower morbidity in the peri-operative glucocorticosteroid group. The number needed to treat to prevent one major complication with hydrocortisone is four patients. Two studies demonstrated that dexamethasone was associated with a statistically significantly improved median overall survival in pancreatic cancer.

Conclusion

This is the first systematic review conducted to investigate the significance of peri-operative glucocorticosteroid in patients undergoing pancreatic resection. This review shows a correlation of positive outcomes with the administration of glucocorticosteroid in the peri-operative setting following a major pancreatic resection.. More randomised clinical trials are required to confirm if this is a true effect, as it would have significant implications.

中文翻译：

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大胰腺切除术围手术期使用糖皮质激素的结果：系统评价

背景

越来越多的证据表明围手术期糖皮质激素可以改善大手术后的全身反应。初步证据表明，围手术期使用糖皮质激素可减少术后并发症。这些积极的关联已经在一系列不同的手术中观察到，包括腹腔内、胸腔、心脏和骨科手术。本综述旨在探讨围手术期糖皮质激素对胰腺大切除术的影响。

方法

基于在 Medline 和 Embase 数据库中的搜索进行了系统评价。遵循 PRISMA 系统评价指南。

结果

共分析了五项研究；三项随机对照试验和两项回顾性队列研究。患者总数为 1042。使用的糖皮质激素是静脉内氢化可的松或地塞米松。三项研究报告了围手术期糖皮质激素组的发病率显着降低。预防氢化可的松的一种主要并发症需要治疗的人数是四名患者。两项研究表明，地塞米松与胰腺癌中位总生存期的统计学显着改善相关。

结论

这是第一次进行系统评价，以调查围手术期糖皮质激素在接受胰腺切除术的患者中的意义。这篇综述显示了在大胰腺切除术后围手术期使用糖皮质激素的积极结果的相关性。需要更多的随机临床试验来确认这是否是真正的效果，因为它会产生重大影响。