Perioperative Dexamethasone Is Associated With Higher Short-Term Mortality in Reconstructive Head and Neck Cancer Surgery
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CitationKainulainen, Satu. Aro, Katri. Koivusalo, Anna-Maria. Wilkman, Tommy. Roine, Risto P. Aronen, Pasi. Törnwall, Jyrki. Lassus, Patrik. (2020). Perioperative Dexamethasone Is Associated With Higher Short-Term Mortality in Reconstructive Head and Neck Cancer Surgery. Journal of oral and maxillofacial surgery, 78 (10) , 1835-1845. 10.1016/j.joms.2020.05.004.
Studies of the effects of perioperative dexamethasone (DEX) during oncologic surgery are scarce. The first aim of the present study was to clarify whether perioperative DEX affects the short-term mortality in patients with head and neck cancer (HNC). The second aim was to analyze the causes of death and predictors affecting long-term mortality.
Patients and Methods
The present prospective, double-blind randomized, controlled study included patients with HNC who had undergone microvascular reconstruction from 2008 through 2013. The patients were randomized into 2 groups: the receipt of perioperative DEX for 3 days (study group) or no DEX (control group). The patients’ data and cause of death were registered until the end of 2017. The primary cause of death was used in the analyses.
A total of 93 patients were included in the present study: 51 in the DEX group (study group) and 42 in the NON-DEX group (control group). Altogether 38 patients died during a median follow-up period of 5.3 years. During the first year, more deaths had occurred in the DEX group than in the NON-DEX group: at 1 month, 4% versus 0%; at 6 months, 14% versus 0%; and at 12 months, 22% versus 5% (P = .043). The overall survival rate for all patients was 59%. HNC was the primary cause of death for most of the patients who died. On univariate analysis, the deceased patients had more advanced disease (higher T classification, P = .002; higher stage, P = .008), a greater need for a gastrostoma (P = .002), more often received postoperative chemotherapy (P = .005), and more often had locoregional (P = .025) or distal (P < .001) metastases. In the multivariate Cox model, the most important long-term predictors of death were the presence of distant metastases (P < .001), a Charlson comorbidity index (CCI) of 5 to 9 (P < .001), and the use of perioperative DEX (P = .004).
The use of perioperative DEX was associated with higher short-term mortality after reconstructive HNC surgery. The most important long-term predictors of death were the receipt of DEX, the presence of distant metastases, and a CCI of 5 to 9. These findings do not encourage the routine use of perioperative DEX for these patients.
Surgery for advanced head and neck cancer (HNC) will often be mutilating, and the large defects that result from tumor resection will require reconstruction with free flaps. The complexity of the surgery with the possible complications influences the survival of patients with HNC. The 5-year disease-specific survival of patients with head and neck squamous cell cancer (HNSCC) has improved during previous decades from 55 to 66%.
1,2 However, the overall survival (OS) at 5 years has been lower, reported to be ∼50 to 60%.3, 4,5 With an aging population, the patients with HNC undergoing surgery have a so been aging, with an increasing burden of comorbidities.
The occurrence of postoperative complications after free flap reconstruction for HNC impairs survival.6,7,8 Perioperative glucocorticoids (GCs), mainly dexamethasone (DEX), have been widely used in HNC surgery because of their anti-inflammatory effects, and numerous patients with HNC have received GCs for the prevention of pain, swelling, nausea, and vomiting during their perioperative treatment. However, the safety of GCs has remained unclear. Only a few studies have evaluated the influence of perioperative DEX on the oncologic surgery outcomes. de Oliveira et al 9 did not find a significant association between the perioperative administration of DEX and tumor recurrence in 260 patients undergoing for ovarian cancer. Yu et al 10studied the effects of perioperative DEX in 515 patients with rectal cancer who had undergone radical surgery. They reported that patients who had received DEX had significantly lower 3-year disease-free survival and OS.10
We have previously shown that the use of perioperative DEX increases the incidence of major complications in patients with HNC undergoing microvascular reconstruction, which could also have affected patient survival.11
Thus, the purpose of the present study was to investigate whether the use of perioperative DEX would influence the short-term survival of patients with HNC. The second aim was to assess the causes of death and the factors associated with mortality during long-term follow-up of patients who had undergone surgery and reconstruction for HNC
Link to the original itemhttp://dx.doi.org/10.1016/j.joms.2020.05.004
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