Impact of Perioperative Steroid Administration in Patients Undergoing Major Hepatectomy with Extrahepatic Bile Duct Resection: A Randomized Controlled Trial.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
25
04
2020
pubmed:
25
6
2020
medline:
5
3
2021
entrez:
25
6
2020
Statut:
ppublish
Résumé
To date, five randomized controlled trials have assessed the clinical benefit of perioperative steroid administration in hepatectomy; however, all of these studies involved a substantial number of 'minor' hepatectomies. The benefit of steroid administration for patients undergoing 'complex' hepatectomy, such as major hepatectomy with extrahepatic bile duct resection, is still unclear. This study aimed to evaluate the clinical benefit of perioperative steroid administration for complex major hepatectomy. Patients with suspected hilar malignancy scheduled to undergo major hepatectomy with extrahepatic bile duct resection were randomized into either the control or steroid groups. The steroid group received hydrocortisone 500 mg immediately before hepatic pedicle clamping, followed by hydrocortisone 300 mg on postoperative day (POD) 1, 200 mg on POD 2, and 100 mg on POD 3. The control group received only physiologic saline. The primary endpoint was the incidence of postoperative liver failure. A total of 94 patients were randomized to either the control (n = 46) or steroid (n = 48) groups. The two groups had similar baseline characteristics; however, there were no significant differences between the groups in the incidence of grade B/C postoperative liver failure (control group, n = 8, 17%; steroid group, n = 4, 8%; p = 0.188) and other complications. Serum bilirubin levels on PODs 2 and 3 were significantly lower in the steroid group than those in the control group; however, these median values were within normal limits in both groups. Perioperative steroid administration did not reduce the risk of postoperative complications, including liver failure following major hepatectomy with extrahepatic bile duct resection.
Sections du résumé
BACKGROUND
BACKGROUND
To date, five randomized controlled trials have assessed the clinical benefit of perioperative steroid administration in hepatectomy; however, all of these studies involved a substantial number of 'minor' hepatectomies. The benefit of steroid administration for patients undergoing 'complex' hepatectomy, such as major hepatectomy with extrahepatic bile duct resection, is still unclear. This study aimed to evaluate the clinical benefit of perioperative steroid administration for complex major hepatectomy.
METHODS
METHODS
Patients with suspected hilar malignancy scheduled to undergo major hepatectomy with extrahepatic bile duct resection were randomized into either the control or steroid groups. The steroid group received hydrocortisone 500 mg immediately before hepatic pedicle clamping, followed by hydrocortisone 300 mg on postoperative day (POD) 1, 200 mg on POD 2, and 100 mg on POD 3. The control group received only physiologic saline. The primary endpoint was the incidence of postoperative liver failure.
RESULTS
RESULTS
A total of 94 patients were randomized to either the control (n = 46) or steroid (n = 48) groups. The two groups had similar baseline characteristics; however, there were no significant differences between the groups in the incidence of grade B/C postoperative liver failure (control group, n = 8, 17%; steroid group, n = 4, 8%; p = 0.188) and other complications. Serum bilirubin levels on PODs 2 and 3 were significantly lower in the steroid group than those in the control group; however, these median values were within normal limits in both groups.
CONCLUSION
CONCLUSIONS
Perioperative steroid administration did not reduce the risk of postoperative complications, including liver failure following major hepatectomy with extrahepatic bile duct resection.
Identifiants
pubmed: 32578066
doi: 10.1245/s10434-020-08745-7
pii: 10.1245/s10434-020-08745-7
doi:
Substances chimiques
Adrenal Cortex Hormones
0
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
121-130Références
Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. The New England journal of medicine. 2002;346(15):1128–1137.
doi: 10.1056/NEJMsa012337
Eppsteiner RW, Csikesz NG, Simons JP, Tseng JF, Shah SA. High volume and outcome after liver resection: surgeon or center? Journal of gastrointestinal surgery. 2008;12(10):1709–1716; discussion 1716.
Yasunaga H, Horiguchi H, Matsuda S, et al. Relationship between hospital volume and operative mortality for liver resection: data from the Japanese Diagnosis Procedure Combination database. Hepatology research. 2012;42(11):1073–1080.
doi: 10.1111/j.1872-034X.2012.01022.x
Onoe S, Yokoyama Y, Ebata T, et al. Comparison between autologous and homologous blood transfusions in liver resection for biliary tract cancer: a propensity score matching analysis. Journal of hepato-biliary-pancreatic sciences. 2018;25(12):550–559.
pubmed: 30428161
Pulitan C, Aldrighetti L, Arru M, et al. Preoperative Methylprednisolone Administration Maintains Coagulation Homeostasis in Patients Undergoing Liver Resection. Shock. 2007;28(4):401–405.
doi: 10.1097/shk.0b013e318063ed11
Schmidt SC, Hamann S, Langrehr JM, et al. Preoperative high-dose steroid administration attenuates the surgical stress response following liver resection: results of a prospective randomized study. Journal of hepato-biliary-pancreatic surgery. 2007;14(5):484–492.
doi: 10.1007/s00534-006-1200-7
Li N, Gu WL, Weng JF, et al. Short-term administration of steroids does not affect postoperative complications following liver resection: evidence from a meta-analysis of randomized controlled trials. Hepatology research. 2015;45(2):201–209.
doi: 10.1111/hepr.12332
Yamashita Y, Shimada M, Hamatsu T, et al. Effects of preoperative steroid administration on surgical stress in hepatic resection: prospective randomized trial. Archives of surgery. 2001;136(3):328–333.
doi: 10.1001/archsurg.136.3.328
Muratore A, Ribero D, Ferrero A, Bergero R, Capussotti L. Prospective randomized study of steroids in the prevention of ischaemic injury during hepatic resection with pedicle clamping. The British journal of surgery. 2003;90(1):17–22.
doi: 10.1002/bjs.4055
Aldrighetti L, Pulitano C, Arru M, et al. Impact of preoperative steroids administration on ischemia-reperfusion injury and systemic responses in liver surgery: a prospective randomized study. Liver transplantation. 2006;12(6):941–949.
doi: 10.1002/lt.20745
Hayashi Y, Takayama T, Yamazaki S, et al. Validation of perioperative steroids administration in liver resection: a randomized controlled trial. Annals of surgery. 2011;253(1):50–55.
doi: 10.1097/SLA.0b013e318204b6bb
Yokoyama Y, Nishio H, Ebata T, Igami T, Sugawara G, Nagino M. Value of indocyanine green clearance of the future liver remnant in predicting outcome after resection for biliary cancer. The British journal of surgery. 2010;97(8):1260–1268.
doi: 10.1002/bjs.7084
Nagino M, Kamiya J, Kanai M, et al. Hepaticojejunostomy using a Roux-en-Y jejunal limb via the retrocolic-retrogastric route. Langenbecks Arch Surg. 2002;387(3–4):188–189.
doi: 10.1007/s00423-002-0304-z
Nagino M, Nishio H, Ebata T, Yokoyama Y, Igami T, Nimura Y. Intrahepatic cholangiojejunostomy following hepatobiliary resection. The British journal of surgery. 2007;94(1):70–77.
doi: 10.1002/bjs.5531
Ebata T, Yokoyama Y, Igami T, et al. Hepatopancreatoduodenectomy for cholangiocarcinoma: a single-center review of 85 consecutive patients. Ann Surg. 2012;256(2):297–305.
doi: 10.1097/SLA.0b013e31826029ca
Kanazawa H, Nagino M, Kamiya S, et al. Synbiotics reduce postoperative infectious complications: a randomized controlled trial in biliary cancer patients undergoing hepatectomy. Langenbecks Arch Surg. 2005;390(2):104–113.
doi: 10.1007/s00423-004-0536-1
Sugawara G, Nagino M, Nishio H, et al. Perioperative synbiotic treatment to prevent postoperative infectious complications in biliary cancer surgery: a randomized controlled trial. Annals of surgery. 2006;244(5):706–714.
doi: 10.1097/01.sla.0000219039.20924.88
Rahbari NN, Garden OJ, Padbury R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011;149(5):713–724.
doi: 10.1016/j.surg.2010.10.001
Sugawara G, Yokoyama Y, Ebata T, et al. Duration of Antimicrobial Prophylaxis in Patients Undergoing Major Hepatectomy With Extrahepatic Bile Duct Resection: A Randomized Controlled Trial. Annals of surgery. 2018;267(1):142–148.
doi: 10.1097/SLA.0000000000002049
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infection control and hospital epidemiology. 1999;20(4):250–278; quiz 279–280.
Shigeta H, Nagino M, Kamiya J, et al. Bacteremia after hepatectomy: an analysis of a single-center, 10-year experience with 407 patients. Langenbecks Arch Surg. 2002;387(3–4):117–124.
doi: 10.1007/s00423-002-0301-2
Simon R. Optimal two-stage designs for phase II clinical trials. Controlled clinical trials. 1989;10(1):1–10.
doi: 10.1016/0197-2456(89)90015-9
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of surgery. 2004;240(2):205–213.
doi: 10.1097/01.sla.0000133083.54934.ae
Jaeschke H. Mechanisms of reperfusion injury after warm ischemia of the liver. Journal of hepato-biliary-pancreatic surgery. 1998;5(4):402–408.
doi: 10.1007/s005340050064
Jaeschke H. Mechanisms of Liver Injury. II. Mechanisms of neutrophil-induced liver cell injury during hepatic ischemia-reperfusion and other acute inflammatory conditions. American journal of physiology. Gastrointestinal and liver physiology. 2006;290(6):G1083–1088.
Wang M, Sakon M, Umeshita K, et al. Prednisolone suppresses ischemia-reperfusion injury of the rat liver by reducing cytokine production and calpain mu activation. Journal of hepatology. 2001;34(2):278–283.
doi: 10.1016/S0168-8278(00)00017-9
Richardson AJ, Laurence JM, Lam VW. Use of pre-operative steroids in liver resection: a systematic review and meta-analysis. HPB (Oxford). 2014;16(1):12–19.
doi: 10.1111/hpb.12066
Takagi T, Yokoyama Y, Kokuryo T, et al. A clear difference between the outcomes after a major hepatectomy with and without an extrahepatic bile duct resection. World J Surg. 2017;41(2):508–515.
doi: 10.1007/s00268-016-3744-2