Impact of preoperative steroids administration on ischemia-reperfusion injury and systemic responses in liver surgery: A prospective randomized study

Abstract

Hepatic injury secondary to warm ischemia-reperfusion (I/R) injury and alterations in haemostatic parameters are often unavoidable events after major hepatic resection. The release of inflammatory mediator is believed to play a significant role in the genesis of these events. It has been suggested that preoperative steroid administration may reduce I/R injury and improve several aspects of the surgical stress response. The aim of this prospective randomized study was to investigate the clinical benefits on I/R injury and systemic responses of preoperatively administered corticosteroids. Seventy-six patients undergoing liver resection were randomized either to a steroid group or to a control group. Patients in the steroid group received preoperatively 500 mg of methylprednisolone. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, coagulation parameters, and inflammatory mediators, interleukin 6 and tumor necrosis factor alpha were compared between the 2 groups. Length of stay, and type and number of complications were recorded as well. Postoperative serum levels of ALT, AST, total bilirubin, and inflammatory cytokines were significantly lower in the steroid than in the control group at postoperative days 1 and 2. Changes in hemostatic parameters were also significantly attenuated in the steroid group. In conclusion, the incidence of postoperative complications in the steroid group tended to be significantly lower than the control group. It is of clinical interest that preoperative steroids administration before major surgery may reduce I/R injury, maintain coagulant/anticoagulant homeostasis, and reduce postoperative complications by modulating the inflammatory response. The human body reacts to surgical stimuli through various systemic responses including the endocrine, metabolic, coagulation, and immune systems. However, extended damage may result in an exaggerated systemic response with an overwhelming activation of immune cells and the release of various mediators of stress. [1][2][3] The systemic reaction to the operation is considered to be equivalent to the systemic inflammation response syndrome, mainly caused by cytokine networks. 4,5 Raised levels of inflammatory cytokines have been related to higher postoperative mortality and morbidity rates. 2,3,6 Therefore, increased attention has evolved toward modulating potentially deleterious inflammatory response to the operation.The anti-inflammatory and immune modulating effects of steroids have been known for decades and have found extensive therapeutic use in a wide range of diseases in which inflammatory responses play major role. 7,8 Several trials have investigated the benefits of administering corticosteroids as a modulator of cytokine response in patients undergoing elective cardiothoracic or gastrointestinal surgery, as well as in cases of septic shock, suggesting that several aspects of the surgical stress responses, organ dysfunction, and postAbbreviations: POD, postoperative day; ALT, alanine aminotr...

Determination of urinary trypsin inhibitor provides insight into postoperative complications in patients following esophagectomy

“…Shimada et al (34) reported that morbidity rates including hyperbilirubinemia, anastomotic leakage, and liver dysfunction in patients with esophagectomy were significantly lower in a steroid group than in a non-steroid group. In addition, the median hospital stay was reported to be shorter in a steroid group, and adverse effects of steroid use, such as abnormality in glucose tolerance and delay in wound healing, did not occur following liver surgery (35). In the present study, the level of urine UTI in the steroid group was decreased compared to that in the non-steroid group (Fig.…”

Molecular Mediators of Liver Ischemia and Reperfusion Injury: A Brief Review

“…A recent prospective clinical trial assessed the use of preoperative steroid administration on outcome after hepatectomy (108). Patients (n = 36) treated with preoperative methylprednisolone (500 mg) before induction of anesthesia had lower serum transaminases, coagulation parameters, and inflammatory cytokines (TNF-α and IL-6).…”

Effects of adjuvant therapy on the outcomes of surgical management of extrahepatic biliary atresia

“…8 It is of great interest that the possible clinical effects of a high pulse dose of steroids include the prevention of bacterial translocation and immunosuppression induced by the operation itself. [9][10] Concerns exist on the clinical use of high-dose steroids, because of the possible side effects and the risk of adrenal suppression. However, no adverse effects have actually been reported in the previous study about high-dose steroids.…”