Corewell Health William Beaumont University Hospital Royal Oak, MI
Zain Ul Abideen, MBBS1, Usman Bin Hameed, MD2, Muhammad Hassan Waseem, MBBS3, Ammad Javaid. Chaudhary, MD4, Noor Ul Huda Ramzan, MD5, Sania Aimen, MBBS6, Muhammad Shahzil, MD7, Zuhaab Khan, MD8, Rao Afzal, MD9, Fariha Hasan, MD10, Muhammad Mushtaq, DO11 1King Edward Medical University, Lahore, Punjab, Pakistan; 2Corewell Health William Beaumont University Hospital, Royal Oak, MI; 3Allama Iqbal Medical College, Lahore, Punjab, Pakistan; 4Henry Ford Health, Detroit, MI; 5University of Texas Southwestern Medical Center, Dallas, TX; 6Quetta Institute of Medical Sciences, Quetta, Balochistan, Pakistan; 7Penn State Health Milton S. Hershey Medical Center, Hershey, PA; 8University of Pittsburgh Medical Center, Pittsburgh, PA; 9The University of Texas Health Science Center, Houston, TX; 10Cooper University Hospital, Camden, NJ; 11University of Texas Medical Branch, Galveston, TX Introduction: Pancreaticoduodenectomy, a very common procedure, is characterized by a high likelihood of postoperative complications. Whether anti-inflammatory agents reduce postoperative complications or not is a topic of debate. This meta-analysis aimed to assess the efficacy of glucocorticoids regarding the post-pancreatoduodenectomy outcomes. Methods: Electronic databases like PubMed, Cochrane Central, and ScienceDirect were searched from inception till November 2024. The Risk Ratios (RR) and Mean Differences (MD) along with a 95% Confidence Interval (CI) were pooled under the random effects model with Review Manager 5.4.1 for the dichotomous and continuous outcomes. The primary and secondary outcomes of interest were major complications, overall complications, postoperative pancreatic fistula (POPF), all infectious complications, bile leakage, post-pancreaticoduodenectomy hemorrhage (PPH), delayed gastric emptying (DGE), reoperation, 30-day mortality, readmission and postoperative length of hospital stay. The major complications were defined as Clavien-Dindo scale ≥ 3. The quality assessment was done by the Newcastle Ottawa Scale and the Cochrane Risk of Bias (RoB) 2.0 tool. Results: Four studies pooling a total of 1,076 patients were included in this meta-analysis. The glucocorticoids significantly reduced the overall infectious complications (RR=0.60, 95%CI:[0.45,0.81]; p=0.0007; I2=0%). Similarly, the postoperative length of hospital stay (LOS) was also reduced in the glucocorticoid group (MD= -2.53 days; 95%CI:[-3.92,-1.14]; p=0.0004; I2=0%). The overall complications (RR= 0.69; 95%CI:[0.43,1.09]; p=0.11; I2=73%) and major complications (RR= 0.80; 95%CI:[0.58,1.11]; p=0.18; I2=0%) showed no difference between the two groups. Other outcomes including the POPF (RR= 0.77; 95%CI:[0.55,1.06]; p=0.11; I2=0%), PPH (RR= 0.79; 95%CI:[0.46,1.37]; p=0.40; I2=0%), DGE (RR= 0.81; 95%CI:[0.59,1.11]; p=0.19; I2=0%), reoperation (RR= 0.52; 95%CI:[0.16,1.64]; p=0.26; I2=22%), readmission (RR= 0.85; 95%CI:[0.55,1.30]; p=0.45; I2=0%), and 30-day mortality (RR= 0.99; 95%CI:[0.34,2.92]; p=0.99; I2=0%) were also comparable between the two arms. Discussion: Glucocorticoids significantly reduce infectious complications and shorten the postoperative LOS after pancreaticoduodenectomy, suggesting potential benefits in improving recovery. However, they show no significant impact on overall or major complications, pancreatic fistulas, or mortality, indicating limited effects on other postoperative outcomes.
Figure: Forest plots showing that perioperative glucocorticoids significantly reduced infectious complications and length of hospital stay, with no effect on major complications after pancreaticoduodenectomy
Figure: Baseline characteristics of the included studies
Disclosures: Zain Ul Abideen indicated no relevant financial relationships. Usman Bin Hameed indicated no relevant financial relationships. Muhammad Hassan Waseem indicated no relevant financial relationships. Ammad Chaudhary indicated no relevant financial relationships. Noor Ul Huda Ramzan indicated no relevant financial relationships. Sania Aimen indicated no relevant financial relationships. Muhammad Shahzil indicated no relevant financial relationships. Zuhaab Khan indicated no relevant financial relationships. Rao Afzal indicated no relevant financial relationships. Fariha Hasan indicated no relevant financial relationships. Muhammad Mushtaq indicated no relevant financial relationships.
Zain Ul Abideen, MBBS1, Usman Bin Hameed, MD2, Muhammad Hassan Waseem, MBBS3, Ammad Javaid. Chaudhary, MD4, Noor Ul Huda Ramzan, MD5, Sania Aimen, MBBS6, Muhammad Shahzil, MD7, Zuhaab Khan, MD8, Rao Afzal, MD9, Fariha Hasan, MD10, Muhammad Mushtaq, DO11. P0018 - Effect of Perioperative Glucocorticoid Administration on Pancreaticoduodenectomy Outcomes: A Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
