Preoperative single-dose systemic steroid in major head and neck surgery (J-SUPPORT 2002, PreSte-HN Study): a phase III, placebo-controlled, randomized, double-blind study
In brief
Pre-op dexamethasone lowers inflammation but does not hasten recovery after head-neck surgery
In a double-blind trial of 180 patients undergoing free-flap head and neck cancer resection, a single 8 mg dose of dexamethasone reduced postoperative IL-6 and CRP levels but showed no difference in quality-of-recovery scores, pain, nausea, or length of stay compared with placebo. The findings suggest that controlling inflammation alone is insufficient to improve recovery in this high-risk surgery.
- Journal
- International journal of clinical oncology (Q1)
- Published
- 21 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Takayuki Imai, Kohtaro Eguchi, Takeshi Shinozaki, Seiichi Yoshimoto, Sadamoto Zenda, Takuhiro Yamaguchi, et al.
- PMID
- 42479256
- DOI
- 10.1007/s10147-026-03138-4
Why clinicians should know about it
- Picked for Hematology (paper of the day, 22 July 2026): Phase III RCT, practice-changing for antiemetic guidelines
Abstract
BACKGROUND: Enhanced Recovery After Surgery programs have been adopted for head and neck cancer surgery with free tissue transfer reconstruction, but postoperative recovery remains difficult because of the high invasiveness of this procedure. Corticosteroids administered before surgery reduce pain, nausea, and systemic inflammation in other surgical settings, but their benefit in this context is uncertain. METHODS: This phase III, multicenter, randomized, double-blind, placebo-controlled trial was conducted at three tertiary cancer centers in Japan. A total of 180 adults undergoing head and neck cancer surgery with free tissue transfer reconstruction were randomly assigned to receive a single intravenous dose of 8 mg dexamethasone phosphate or placebo before surgery. The primary outcome was postoperative quality of recovery, assessed by total scores on the Japanese version of the Quality of Recovery questionnaire on postoperative days 2 and 4. Secondary outcomes included postoperative pain, nausea, systemic inflammatory markers, postoperative complications, and length of hospital stay. RESULTS: Among 178 evaluable patients, postoperative quality of recovery did not differ significantly between the dexamethasone and placebo groups. No significant differences were observed in postoperative pain or nausea. Dexamethasone significantly reduced postoperative serum interleukin-6 and C-reactive protein levels but did not improve patient-reported recovery or shorten hospitalization. Overall postoperative complication rates were similar between the groups. CONCLUSIONS: Preoperative dexamethasone reduced systemic inflammation but did not improve postoperative recovery, pain, or nausea after head and neck cancer surgery with free tissue transfer reconstruction. Inflammation control alone may be insufficient to enhance recovery after highly invasive surgery.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.