Design: Phase 3, multicentre, randomised, double-blind, placebo-controlled trial
Population: 180 adults having head and neck cancer surgery with free tissue transfer in Japan
Primary outcome: Quality of recovery score on postoperative days 2 and 4
Effect: No significant difference; IL-6 and CRP lower with dexamethasone

A phase 3, multicentre, double-blind, placebo-controlled trial at three Japanese cancer centres (International Journal of Clinical Oncology, 21 July 2026) randomised 180 adults having head and neck cancer resection with free tissue transfer to a single 8 mg intravenous dose of dexamethasone or placebo before surgery.

Among 178 evaluable patients, quality of recovery scores on days 2 and 4 did not differ. Neither did pain, nausea, complications or length of stay. Dexamethasone did lower interleukin-6 and C-reactive protein after surgery.

Steroids are often included in enhanced recovery bundles on the strength of evidence from less extensive operations. This trial shows that damping inflammation is not the same as helping patients recover after an operation of this size. It found no harm either, so dexamethasone given for nausea prophylaxis need not be withheld, but it should not be counted on to improve recovery in this group.

Do not expect a single preoperative steroid dose to improve recovery after free-flap head and neck surgery.
Dexamethasone for nausea prophylaxis remains reasonable; no extra complications were seen.
Focus enhanced recovery effort on nutrition, early mobilisation, analgesia and airway care.
Do not read a fall in CRP as evidence that the patient is recovering better.

Why it matters

It removes an assumed benefit from enhanced recovery bundles for the largest head and neck operations.

The statistics, in plain English

A well-run, blinded phase 3 trial with a negative primary outcome is strong evidence that any benefit, if present, is small. The fall in IL-6 and CRP shows the drug worked biologically, which makes the null clinical result more convincing, not less.