High-dose vs. low-dose preoperative dexamethasone for systemic inflammation and recovery after esophagectomy: a randomized controlled trial protocol

INTRODUCTION: Esophagectomy provokes an intense systemic inflammatory response that is significantly associated with postoperative morbidities. Whether a single preoperative high-dose dexamethasone can attenuate this response and improve recovery remains unknown. PATIENTS AND METHODS: This single-center, randomized, double-blind, parallel-group trial will enroll 82 adults undergoing elective transthoracic esophagectomy at the First Affiliated Hospital of Soochow University, Suzhou, China. Patients will be randomly assigned (1:1) to receive intravenous dexamethasone 15 mg (high-dose) or 5 mg (low-dose) during anesthesia induction. Both groups will receive standardized general anesthesia and perioperative care. The primary outcome is the peak plasma C-reactive protein (CRP) level within 72 h after surgery. Secondary outcomes include CRP values at 24, 48 and 72 h; 72-h recovery quality, assessed using the 15-item quality of recovery scale; cumulative 72-h opioid consumption; in-hospital major complications (anastomotic leakage, mechanical ventilation > 48 h, pulmonary infection, renal failure, reoperation, death); 7-d hyperglycemic events (> 10 mmol/L); and length of postoperative hospital stay. DISCUSSION: By comparing two clinically relevant dexamethasone doses, this trial will provide high-quality evidence on the efficacy and safety of using 15 mg dexamethasone to mitigate excessive systemic inflammation and improve recovery after esophagectomy. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2500109536; registered on September 19, 2025).