title: Dexamethasone in head and neck cancer patients with microvascular reconstruction: No benefit, more complications.
abstract: Glucocorticoids are widely used in association with major surgery of the head and neck to improve postoperative rehabilitation, shorten intensive care unit and hospital stay, and reduce neck swelling. This study aimed to clarify whether peri- and postoperative use of dexamethasone in reconstructive head and neck cancer surgery is associated with any advantages or disadvantages.
  
  
  
  This prospective double-blind randomized controlled trial comprised 93 patients. A total dose of 60mg of dexamethasone was administered to 51 patients over three days peri- and postoperatively. The remaining 42 patients served as controls. The main primary outcome variables were neck swelling, length of intensive care unit and hospital stay, duration of intubation or tracheostomy, and delay to start of possible radiotherapy. Complications were also recorded.
  
  
  
  No statistical differences emerged between the two groups in any of the main primary outcome variables. However, there were more major complications, especially infections, needing secondary surgery within three weeks of the operation in patients receiving dexamethasone than in control patients (27% vs. 7%, p=0.012).
  
  
  
  The use of dexamethasone in oral cancer patients with microvascular reconstruction did not provide a benefit. More major complications, especially infections, occurred in patients receiving dexamethasone. Our data thus do not support the use of peri- and postoperative dexamethasone in oropharyngeal cancer patients undergoing microvascular reconstruction.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland. Electronic address: satu.kainulainen@hus.fi.
authors.forename: S
authors.initials: S
authors.lastname: Kainulainen
authors.affiliation: Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Törnwall
authors.affiliation: Department of Anesthesia and Intensive Care Unit, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: A M
authors.initials: AM
authors.lastname: Koivusalo
authors.affiliation: Institute of Dentistry, University of Eastern Finland, Kuopio, Finland; Department of Oral and Maxillofacial Surgery, Kuopio University Hospital, Kuopio, Finland.
authors.forename: A L
authors.initials: AL
authors.lastname: Suominen
authors.affiliation: Department of Plastic Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Lassus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006258:Head and Neck Neoplasms / Q000098:blood supply / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures
chemical_list: D003907:Dexamethasone
keywords: Complications; Dexamethasone; Glucocorticoid; Head and neck cancer; Microvascular reconstruction