S25 Effect of Perioperative Glucocorticoid Administration on Pancreaticoduodenectomy Outcomes: A Systematic Review and Meta-Analysis

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 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, all infectious complications, bile leakage, post-pancreaticoduodenectomy hemorrhage, delayed gastric emptying, 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 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 was also reduced in the glucocorticoid group (mean differences = -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 2 groups. Other outcomes including the postoperative pancreatic fistula (RR = 0.77; 95% CI: [0.55, 1.06]; P = 0.11; I2 = 0%), post-pancreaticoduodenectomy hemorrhage (RR = 0.79; 95% CI: [0.46,1.37]; P = 0.40; I2 = 0%), delayed gastric emptying (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 2 arms. Conclusion: Glucocorticoids significantly reduce infectious complications and shorten the postoperative length of hospital stay 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.