Preoperative High-Dose Corticosteroids in Digestive Cancer Surgery: A Randomized Clinical Trial.

Summary

In this double-blind, placebo-controlled multicenter trial across 23 French hospitals, 1,210 patients undergoing elective curative digestive cancer surgery were randomized to intravenous methylprednisolone 20 mg/kg or placebo. Among 1,188 patients with 30-day follow-up, major postoperative complications occurred in 23% versus 20%, respectively, without a statistically significant difference, and no secondary outcome was improved.

Key Findings

• Among 1,188 patients with 30-day follow-up, major postoperative complications occurred in 23% of the methylprednisolone group and 20% of the placebo group, with no significant difference (P = .16).
• Postoperative infections, intra-abdominal infections, unsatisfactory wound healing, and hospital length of stay did not differ significantly between groups.
• The trial concluded that preoperative high-dose corticosteroids provided no postoperative benefit and should not be recommended routinely.

Clinical Implications

Routine administration of a preoperative pulse dose of methylprednisolone 20 mg/kg should not be recommended for elective digestive cancer surgery solely to reduce postoperative complications or inflammation. Clinicians should continue to use corticosteroids only for established indications and weigh procedure-specific risks and benefits.

Limitations

• The findings apply primarily to elective digestive cancer surgery with curative intent and may not generalize to emergency surgery or isolated hepatic surgery.
• Follow-up for the primary analysis was limited to 30 postoperative days, so long-term oncologic or functional effects were not established.

Future Directions

Future research should determine whether selected subgroups, specific procedures, or different corticosteroid regimens have distinct effects, while incorporating longer-term oncologic, infectious, and patient-reported outcomes. Current work should prioritize implementation studies that reduce unnecessary perioperative steroid use.