Does perioperative hydrocortisone reduce morbidity after pancreatoduodenectomy? A propensity score matched analysis

The use of steroids in pancreatic surgery may reduce complications through the anti-inflammatory potential. We aimed to evaluate the impact of hydrocortisone (HC) on postoperative morbidity after pancreatoduodenectomy (PD). The data were retrospectively extracted from a prospective clinical database. Complicatons after PD with 100 mg HC intravenously (i.v.) for 48 h and a corresponding propensity score-matched cohort without HC were evaluated by using logistic regression analyses. We analyzed 691 patients who underwent PD over a period of ten years. After propensity score matching, 220 patients (110 patients in each group) remained. Postoperative complications were comparable in both groups (p = 0.56). Major complications (CDC ≥ 3) did not differ significantly, n = 44 (40%) for non-HC n = 45 (40.9%) and HC group (p = 0.89). There was no difference (p = 0.88) in the POPF incidence, non-HC, n = 31 (28.2%) and HC group, n = 30 (27.3%). After stratifying for fistula risk score (FRS), results remained equal and no difference was observed in CDC ≥ 3 in the low (p = 1), intermediate (p = 0.82) and high-risk (p = 0.74) group. HC has been suggested to be effective in reducing postoperative morbidity, but the evidence is controversial. The benefit of HC in reducing postoperative complications after pancreatoduodenectomy cannot be supported in the present study.