High-Dose Corticosteroids Before Digestive Cancer Surgery: JAMA Surgery | August 2026

Introduction:

Major cancer surgery triggers a substantial inflammatory response that may contribute to postoperative complications and delayed recovery. A single preoperative corticosteroid dose has therefore been proposed to blunt this response. The CORTIFRENCH randomized trial evaluated whether high-dose methylprednisolone before elective digestive cancer surgery improves meaningful postoperative outcomes.

Why was this study needed?

Excessive perioperative inflammation has been associated with complications after major surgery.

Corticosteroids can suppress the surgical inflammatory response.

Previous studies were generally small, heterogeneous, and often focused on surrogate inflammatory markers.

Large randomized evidence examining clinically important outcomes in digestive cancer surgery was lacking.

Results:

1,210 patients across 23 French hospitals were randomized to intravenous methylprednisolone 20 mg/kg or placebo at induction of anesthesia.

Major postoperative complications were not reduced with corticosteroids (23% vs 20%).

There was no meaningful benefit in overall infections, intra-abdominal infections, wound healing, or hospital stay.

Thus, suppressing perioperative inflammation pharmacologically did not translate into better clinical recovery.

Clinical Impact:

This large placebo-controlled trial challenges the concept of routinely administering a high-dose corticosteroid pulse solely to improve recovery after digestive cancer surgery. Biological reduction of inflammation should not be assumed to produce better clinical outcomes.

Bottom Line:

A single high dose of methylprednisolone before elective digestive cancer surgery does not reduce major complications, infections, or hospital stay. Preoperative high-dose corticosteroids should therefore not be introduced routinely for postoperative risk reduction in digestive cancer surgery.