Perioperative Dexamethasone Is Associated With Higher Short-Term Mortality in Reconstructive Head and Neck Cancer Surgery

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Kainulainen , S , Aro , K , Koivusalo , A-M , Wilkman , T , Roine , R P , Aronen , P , Törnwall , J & Lassus , P 2020 , ' Perioperative Dexamethasone Is Associated With Higher Short-Term Mortality in Reconstructive Head and Neck Cancer Surgery ' , Journal of Oral and Maxillofacial Surgery , vol. 78 , no. 10 , pp. 1835-1845 . https://doi.org/10.1016/j.joms.2020.05.004

Title: Perioperative Dexamethasone Is Associated With Higher Short-Term Mortality in Reconstructive Head and Neck Cancer Surgery
Author: Kainulainen, Satu; Aro, Katri; Koivusalo, Anna-Maria; Wilkman, Tommy; Roine, Risto P.; Aronen, Pasi; Törnwall, Jyrki; Lassus, Patrik
Other contributor: University of Helsinki, Department of Oral and Maxillofacial Diseases
University of Helsinki, HUS Head and Neck Center
University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine
University of Helsinki, HUS Head and Neck Center
University of Helsinki, University of Helsinki
University of Helsinki, HUS Helsinki and Uusimaa Hospital District
University of Helsinki, HUS Head and Neck Center
University of Helsinki, HUS Musculoskeletal and Plastic Surgery













Date: 2020-10
Language: eng
Number of pages: 11
Belongs to series: Journal of Oral and Maxillofacial Surgery
ISSN: 0278-2391
DOI: https://doi.org/10.1016/j.joms.2020.05.004
URI: http://hdl.handle.net/10138/335844
Abstract: Purpose: 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. Results: 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). Conclusions: 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. (C) 2020 American Association of Oral and Maxillofacial Surgeons
Subject: FREE-FLAP RECONSTRUCTION
SQUAMOUS-CELL CARCINOMA
POSTOPERATIVE COMPLICATIONS
SURGICAL COMPLICATIONS
SURVIVAL
CLASSIFICATION
313 Dentistry
3126 Surgery, anesthesiology, intensive care, radiology
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