Steroids may reduce pancreatic fistula after Whipple, but the evidence is still too thin

Perioperative corticosteroids lowered clinically relevant pancreatic fistula after pancreaticoduodenectomy in a meta-analysis of four randomized trials (454 patients). The reduction was borderline and the trials were too small to confirm it.

• Clinically relevant postoperative pancreatic fistula fell from about 9 to 1 percentage points less with steroids (number needed to treat, 11).
• Mortality and major morbidity did not differ significantly.
• Trial sequential analysis showed the evidence is underpowered, so the result is not yet firm.

Corticosteroids are not ready for routine use after pancreaticoduodenectomy; wait for a larger randomized trial before changing practice.