Perioperative steroid administration reduces overall complications in patients undergoing liver resection: A meta-analysis

Abstract

BACKGROUND Hepatic resection (HR) results in an inflammatory response that can be modified by perioperative steroid administration. However, it remains to be determined if this response's attenuation translates to a reduction in complications. AIM To evaluate if perioperative administration of steroids reduces complications following HR. METHODS A systematic review of randomized controlled trials (RCTs) was conducted on PubMed, Embase, and Cochrane Central Register of Controlled Trials to evaluate the effect of perioperative steroid (compared to placebo or no intervention) use in patients undergoing HR. Clinical outcomes were extracted, and meta-analysis was performed. RESULTS 8 RCTs including 590 patients were included. Perioperative steroid administration was associated with significant reduction in postoperative complications [odds ratios: 0.58; 95% confidence intervals (CI): 0.35-0.97, P = 0.04]. There was also improvement in biochemical and inflammatory markers, including serum bilirubin on postoperative day 1 [MD: -0.27; 95%CI: (-0.47, -0.06), P = 0.01], C-reactive protein on postoperative day 3 [MD: -4.89; 95%CI: (-5.83, -3.95), P < 0.001], and interleukin-6 on postoperative day 1 [MD: -54.84; 95%CI: (-63.91, -45.76), P < 0.001]. CONCLUSION Perioperative steroids administration in HR may reduce overall complications, postoperative bilirubin, and inflammation. Further studies are needed to determine the optimal dose and duration and patient selection.

Impact of perioperative steroid administration in patients undergoing elective liver resection: meta-analysis

“…Hai et al . 52 also found a reduction of overall complications, serum bilirubin, IL-6, and CRP in accordance to our results; however, despite the lower number of trials and patients in their analysis, they also included one non-randomized study 59 , which introduces potential bias and the critical appraisal was rather superficial. Yang et al 53 did not find a difference in postoperative complications, which is mainly attributable to the low power of the data due to the small study population.…”

“…In comparison with the previous systematic reviews on this topic by Hai et al . 52 and Yang et al . 53 , the present meta-analysis included a substantially larger number of trials and patients, resulting in an increased power of the results.…”

“…This systematic review and meta-analysis examined the risk and benefit of perioperative steroid administration in elective liver resection, including two recently published RCTs on this topic 52 , 53 . The aggregated data demonstrate a significant and clinically relevant benefit of the intervention in terms of a reduced postoperative overall complication rate as well as several laboratory parameters of liver function (TSB) and postoperative inflammation (IL-6 and CRP).…”

Ultrasound-guided thermal ablation versus laparoscopic surgery for focal nodular hyperplasia of the liver: A retrospective controlled study

“…In recent years, rehabilitation or enhanced recovery programs for liver surgery have been gradually applied to clinical practice. Relevant clinical studies have shown that compared with traditional standardized treatment, preoperative rehabilitation programs and perioperative steroid administration can effectively reduce overall complications ( 21 , 22 ). In this study, complications of the ablation group were only compared with those of FNH surgical standardized treatment.…”

Inflammation in Hepatocellular Carcinoma Patients Undergoing Hepatectomy: An Important Target for Ongoing Study

“…A recent meta-analysis of randomized trials also demonstrated that steroid administration was associated with fewer postoperative complications, lower bilirubin, C-reactive protein (CRP), and interleukin-6 (IL-6) levels. 6 Multicenter trials are currently planned or underway. The authors of this study provide an important retrospective analysis of the link between liver inflammation and oncologic outcomes with thought-provoking correlations.…”