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Lim JSH, Shelat VG. Liver resection, and technical advances to mitigate post-hepatectomy liver failure. Hepatobiliary Surg Nutr 2024; 13:366-369. [PMID: 38617495 PMCID: PMC11007352 DOI: 10.21037/hbsn-23-95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/20/2023] [Indexed: 04/16/2024]
Affiliation(s)
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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2
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Turan C, Kovács EH, Szabó L, Atakan I, Dembrovszky F, Ocskay K, Váncsa S, Hegyi P, Zubek L, Molnár Z. The Effect of Preoperative Administration of Glucocorticoids on the Postoperative Complication Rate in Liver Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2024; 13:2097. [PMID: 38610862 PMCID: PMC11012757 DOI: 10.3390/jcm13072097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/16/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Glucocorticoids may grant a protective effect against postoperative complications. The evidence on their efficacy, however, has been inconclusive thus far. We investigated the effects of preoperatively administered glucocorticoids on the overall postoperative complication rate, and on liver function recovery in patients undergoing major liver surgery. Methods: We performed a systematic literature search on PubMed, Embase, and CENTRAL in October 2021, and repeated the search in April 2023. Pre-study protocol was registered on PROSPERO (ID: CRD42021284559). Studies investigating patients undergoing liver resections or transplantation who were administered glucocorticoids preoperatively and reported postoperative complications were eligible. Meta-analyses were performed using META and DMETAR packages in R with a random effects model. Risk of bias was assessed using RoB2. Results: The selection yielded 11 eligible randomized controlled trials (RCTs) with 964 patients. Data from nine RCTs (n = 837) revealed a tendency toward a lower overall complication rate with glucocorticoid administration (odds ratio: 0.71; 95% confidence interval: 0.38-1.31, p = 0.23), but it was not statistically significant. Data pooled from seven RCTs showed a significant reduction in wound infections with glucocorticoid administration [odds ratio: 0.64; 95% confidence interval: 0.45-0.92 p = 0.02]. Due to limited data availability, meta-analysis of liver function recovery parameters was not possible. Conclusions: The preoperative administration of glucocorticoids did not significantly reduce the overall postoperative complication rate. Future clinical trials should investigate homogenous patient populations with a specific focus on postoperative liver recovery.
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Affiliation(s)
- Caner Turan
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary
| | - Emőke Henrietta Kovács
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary
- Selye János Doctoral College for Advanced Studies, Semmelweis University, 1085 Budapest, Hungary
| | - László Szabó
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7623 Pécs, Hungary
| | - Işıl Atakan
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Fanni Dembrovszky
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7623 Pécs, Hungary
| | - Klementina Ocskay
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7623 Pécs, Hungary
| | - Szilárd Váncsa
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7623 Pécs, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7623 Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, 1085 Budapest, Hungary
| | - László Zubek
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary
| | - Zsolt Molnár
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary
- Department of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, 61-701 Poznan, Poland
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3
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Keskin ET, Bozkurt M, Şahin M, Özdemir H, Şevik Ç, Canat HL. Effect of preoperative single-dose methylprednisolone administration on early postoperative pain following retrograde intrarenal surgery. Int Urol Nephrol 2024; 56:1253-1258. [PMID: 37999826 DOI: 10.1007/s11255-023-03875-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE To evaluate the effect of preoperative single-dose methylprednisolone use on postoperative early pain after retrograde intrarenal surgery (RIRS). METHODS Patients who had 10-20 mm solitary kidney stones and underwent RIRS procedures were included in this prospective cohort study between February 2022 and May 2023. Patients who were administered methylprednisolone at a dose of 1 mg/kg preoperatively were included in group 1 (n: 31), and the other first 90 patients who met the inclusion criteria and did not receive methylprednisolone before surgery were included in group 2 (n: 90). Demographic data, features of stone, postoperative pain at 1, 6, 12, 18, and 24 hour, the need for analgesics, changes in serum glucose levels, and the prevalence of postoperative fever were compared. RESULTS Age, sex, stone laterality, localization, size, Hounsfield Unit, modified Satava scores, stone-free status, duration of the RIRS procedure, and duration of the ureteral access sheath were found to be similar between groups. Visual Analog Scale (VAS) scores at postoperative 1, 6, 12, 18, and 24 h were found to be statistically significantly lower in group 1 (p = .001, p = .001, p = .001, p = .001, and p = .001, respectively). Similarly, postoperative analgesic requirements were found to be significantly lower in group 1 (p = .048) with a similar postoperative fever rate and changes in serum glucose levels between groups. CONCLUSION Giving a single dose of methylprednisolone at a dose of 1 mg/kg preoperatively for the RIRS procedure is safe and effective at preventing early pain and the need for analgesics after the RIRS procedure.
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Affiliation(s)
- Emin Taha Keskin
- Department of Urology, Başaksehir Çam and Sakura City Hospital, Istanbul, Turkey.
| | - Muammer Bozkurt
- Department of Urology, Başaksehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Mehmet Şahin
- Department of Urology, Başaksehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Harun Özdemir
- Department of Urology, Başaksehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Çağrı Şevik
- Department of Urology, Başaksehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Halil Lutfi Canat
- Department of Urology, Başaksehir Çam and Sakura City Hospital, Istanbul, Turkey
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4
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Chan KS, Tay WX, Cheo FY, Shelat VG. Preoperative transarterial chemoembolization (TACE) + liver resection versus upfront liver resection for large hepatocellular carcinoma (≥5 cm): a systematic review and meta-analysis. Acta Chir Belg 2023; 123:601-617. [PMID: 37681991 DOI: 10.1080/00015458.2023.2256539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 09/04/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) accounts for majority of primary liver cancer. Use of preoperative neoadjuvant transarterial chemoembolization (PN-TACE) may result in tumor shrinkage and improve resectability. This study aims to summarize the outcomes of PN-TACE versus upfront liver resection (Up-LR) in large HCC (≥5 cm). METHODS PubMed, Embase, The Cochrane Library, and Scopus were systematically searched till September 2022 for studies comparing PN-TACE versus Up-LR. The primary study outcomes were overall survival (OS), disease-free survival (DFS), and recurrence. Our secondary outcomes were postoperative morbidity and mortality. RESULTS There were 12 studies with 15 data sets including 3960 patients (PN-TACE n = 2447, Up-LR n = 1513). Majority (89.5%, n = 1250/1397) of patients had Child's A liver cirrhosis. Incidence of Child's B cirrhosis was higher in PN-TACE compared to Up-LR (Odds ratio (OR) 1.69, 95% CI: 1.18, 2.41, p = 0.004). Pooled hazard ratio (HR) for OS showed no significant difference between PN-TACE and Up-LR (HR 0.87, 95% CI: 0.64, 1.18, p = 0.37), but DFS was superior in PN-TACE (HR 0.79, 95% CI: 0.63, 0.99, p = 0.04). Subgroup analysis based on study design failed to show any significant effect in randomized controlled trials (n = 2/15 data sets). However, operating time (mean difference (MD) 31.94 min, 95% CI: 2.42, 61.45, p = 0.03) and blood loss (MD 190.93 ml, 95% CI: 10.22, 317.65, p = 0.04) were higher in PN-TACE. Intrahepatic and extrahepatic recurrence, post-operative morbidity and in-hospital mortality were comparable between PN-TACE and Up-LR. CONCLUSION In retrospective studies, PN-TACE resulted in superior DFS compared to Up-LR. However, this may be confounded by selection bias.
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Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wei Xuan Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Feng Yi Cheo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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5
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Yan X, Huang S, Li F, Jiang L, Jiang Y, Liu J. Short-term outcomes of perioperative glucocorticoid administration in patients undergoing liver surgery: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2023; 13:e068969. [PMID: 37169506 DOI: 10.1136/bmjopen-2022-068969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVE The purpose of this systematic review and meta-analysis was to investigate whether glucocorticoid might be beneficial after hepatectomy. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase, Cochrane Library and Web of Science. ELIGIBILITY CRITERIA We included studies assessing the efficacy of perioperative glucocorticoid administration in patients undergoing liver surgery. DATA EXTRACTION AND SYNTHESIS Four data bases were retrieved for all randomised controlled trials. We considered postoperative complications, hospital stay and postoperative chemistry evaluations as outcomes. Pooled effects of dichotomic variables were expressed as relative risk (RR) with a 95% CI. The mean difference was used for continuous variables and an inverse variance statistical method was adopted. RESULTS Fourteen studies with 1205 patients were included. Lower risk of overall complications was associated with glucocorticoid (RR, 0.77; 95% CI 0.64 to 0.92), while no difference was found in hospital stay (RR, 0.02; 95% CI -0.47 to 0.51). There were also improvements in postoperative chemistry evaluations including interleukin 6 on day 1 and 3, C reactive protein on day 1, 2 and 3, international normalised ratio on day 2, total bilirubin on day 1, 2, 3 and 5, albumin on day 1. CONCLUSION Current evidence indicated that perioperative glucocorticoid administration for patients undergoing hepatectomy reduced the risk of overall complications with inhibited postoperative inflammatory response and improved postoperative liver function. PROSPERO REGISTRATION NUMBER CRD42022307533.
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Affiliation(s)
- Xiangyu Yan
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Songhan Huang
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Feiyu Li
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Liyong Jiang
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yong Jiang
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jun Liu
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital affliated to Shandong First Medical University, Jinan, China
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Gregersen JS, Bazancir LA, Johansson PI, Sørensen H, Achiam MP, Olsen AA. Major open abdominal surgery is associated with increased levels of endothelial damage and interleukin-6. Microvasc Res 2023; 148:104543. [PMID: 37156371 DOI: 10.1016/j.mvr.2023.104543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To examine changes in biomarkers of endothelial glycocalyx shedding, endothelial damage, and surgical stress following major open abdominal surgery and the correlation to postoperative morbidity. INTRODUCTION Major abdominal surgery is associated with high levels of postoperative morbidity. Two possible reasons are the surgical stress response and the impairment of the glycocalyx and endothelial cells. Further, the degree of these responses may correlate with postoperative morbidity and complications. METHODS A secondary data analysis of prospectively collected data from two cohorts of patients undergoing open liver surgery, gastrectomy, esophagectomy, or Whipple procedure (n = 112). Hemodynamics and blood samples were collected at predefined timestamps and analyzed for biomarkers of glycocalyx shedding (Syndecan-1), endothelial activation (sVEGFR1), endothelial damage (sThrombomodulin (sTM)), and surgical stress (IL6). RESULTS Major abdominal surgery led to increased levels of IL6 (0 to 85 pg/mL), Syndecan-1 (17.2 to 46.4 ng/mL), and sVEGFR1 (382.8 to 526.5 pg/mL), peaking at the end of the surgery. In contrast, sTM, did not increase during surgery, but increased significantly following surgery (5.9 to 6.9 ng/mL), peaking at 18 h following the end of surgery. Patients characterized with high postoperative morbidity had higher levels of IL6 (132 vs. 78 pg/mL, p = 0.007) and sVEGFR1 (563.1 vs. 509.4 pg/mL, p = 0.045) at the end of the surgery, and of sTM (8.2 vs. 6.4 ng/mL, p = 0.038) 18 h following surgery. CONCLUSION Major abdominal surgery leads to significantly increased levels of biomarkers of endothelial glycocalyx shedding, endothelial damage, and surgical stress, with the highest levels seen in patients developing high postoperative morbidity.
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Affiliation(s)
| | - Laser Arif Bazancir
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Pär Ingemar Johansson
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Henrik Sørensen
- Department of Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Michael Patrick Achiam
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - August Adelsten Olsen
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Denmark
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Jehan FS, Ganguli S, Song C, Aziz H. Association between chronic steroids and outcomes in hepatobiliary and pancreatic surgery. Am J Surg 2023:S0002-9610(23)00019-3. [PMID: 36702733 DOI: 10.1016/j.amjsurg.2023.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/08/2023] [Accepted: 01/20/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Chronic steroid use has been associated with increased postoperative complication; however, the association between chronic steroids and hepatobiliary and pancreatic surgery through all aspects of disease etiologies and types of surgery performed remains an area of active research. Therefore, this study analyzed the association of chronic steroids use with outcomes after hepatobiliary and pancreatic surgery. METHODS The National Surgical Quality Improvement Program Participant Use Data Files for hepatobiliary and pancreatic surgeries performed between 2015 and 2019 were analyzed for chronic steroid use and postoperative adverse events. RESULTS A total of 54,382 patients underwent hepatobiliary or pancreatic surgery during the study period, of which 1672 (3.1%) were on chronic steroids. In patients undergoing pancreatic surgery, steroid use was associated with higher rates of pneumonia (odds ratio [OR] 1.3, 95% confidence interval [95% CI] 1.2-2.2), unplanned intubation (OR 1.2, 95% CI 1.1-2.3), readmission (OR 1.4, 95% CI 1.3-2.4), intraoperative or postoperative transfusions (OR 1.5, 95% CI 1.2-2.3), being more likely to remain on a ventilator for greater than 48 h (OR 1.4, 95% CI 1.2-1.9), and greater mortality (OR 1.2, 95% CI 1.1-3.1) when compared to those, not on chronic steroids. In patients undergoing hepatobiliary surgery, chronic steroid use was associated with higher rates of sepsis (OR 1.3, 95% CI 1.2-2.9), unplanned intubation (OR 1.4, 95% CI 1.2-2.7), intraoperative or postoperative transfusions (OR 1.5, 95% CI 1.3-2.3), and readmission (OR 1.2, 95% CI 1.0-1.9). There was no difference in pancreatic fistula rates or post-hepatectomy liver failure rates after pancreatic and hepatobiliary resections, respectively. CONCLUSION Chronic steroids use was associated with higher rates of poor outcomes both perioperatively and postoperatively in pancreatic and hepatobiliary surgery. These results will allow clinicians to be better equipped to counsel patients on surgery's increased risks and establish various perioperative protocols for chronic steroid users.
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Affiliation(s)
| | - Sangrag Ganguli
- The George Washington University School of Medicine and Health Sciences, USA
| | | | - Hassan Aziz
- University of Iowa Hospitals and Clinics, USA.
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Liu L, Zhang C, Lu T, Li X, Jiang Z, Tian H, Hao X, Yang K, Guo T. The efficacy and safety of glucocorticoid for perioperative patients with hepatectomy: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2023; 17:59-71. [PMID: 36576056 DOI: 10.1080/17474124.2023.2162878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Glucocorticoids have been used in patients undergoing perioperative hepatectomy, however their safety and efficacy remain controversial. This meta-analysis was conducted to investigate this issue and further provide reference for clinical practice. METHODS PubMed/MEDLINE, Embase, and Cochrane Library were searched for randomized controlled trials (RCTs) from database inception to December 2022. Literature screening and data extraction were performed independently by two reviewers. The methodological quality of the RCTs was assessed using the Jadad scale. RevMan 5.4 was used for the meta-analysis. RESULTS A total of 11 RCTs involving 905 patients were included. Compared with the control group, we found perioperative glucocorticoid administration significantly lowered overall complication rate [RR = 0.67; 95% CI (0.55, 0.83); P = 0.0003], infectious complication rate [RR = 0.41; 95% CI (0.21, 0.82); P = 0.01] and postoperative liver failure [RR = 0.63; 95% CI (0.41, 0.97); P = 0.03]. In addition, glucocorticoids appear to improve liver function (TBil) [MD = -0.36, 95% CI (-0.59, -0.14), P = 0.001] and reduce the release of certain inflammatory cytokines (IL-6) [MD = -48.52, 95% CI (-56.88, -40.16), P < 0.00001]. CONCLUSION Based on the available evidence, glucocorticoids appear to be safe and effective in patients undergoing hepatectomy, but further research is needed.
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Affiliation(s)
- Lili Liu
- The First Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou, Gansu, China.,Department of General Surgery, Gansu Provincial People's Hospital, Lanzhou, Gansu, China
| | - Chengren Zhang
- Department of General Surgery, Gansu Provincial People's Hospital, Lanzhou, Gansu, China.,General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Tingting Lu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China.,Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial People's Hospital, Lanzhou, Gansu, China
| | - Xiong Li
- Department of General Surgery, Gansu Provincial People's Hospital, Lanzhou, Gansu, China.,General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zhiliang Jiang
- The First Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou, Gansu, China.,Department of General Surgery, Gansu Provincial People's Hospital, Lanzhou, Gansu, China
| | - Hongwei Tian
- Department of General Surgery, Gansu Provincial People's Hospital, Lanzhou, Gansu, China
| | - Xiangyong Hao
- Department of General Surgery, Gansu Provincial People's Hospital, Lanzhou, Gansu, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou, Gansu, China
| | - Tiankang Guo
- The First Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou, Gansu, China.,Department of General Surgery, Gansu Provincial People's Hospital, Lanzhou, Gansu, China
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Jötten L, Steinkraus KC, Traub B, Graf S, Mihaljevic AL, Kornmann M, Michalski CW, Hüttner FJ. Impact of perioperative steroid administration in patients undergoing elective liver resection: meta-analysis. BJS Open 2022; 6:6947850. [PMID: 36537738 PMCID: PMC9764439 DOI: 10.1093/bjsopen/zrac139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/21/2022] [Accepted: 10/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Perioperative steroid administration may improve postoperative outcomes in major abdominal surgery by reducing the systemic inflammatory response. The aim of this systematic review was to evaluate the impact of perioperative steroid administration on outcomes after elective liver resection. METHODS PubMed, Cochrane Library, and Web of Science were systematically searched for randomized clinical trials (RCTs) comparing perioperative steroid administration with placebo, standard of care, or no steroids with respect to postoperative outcomes, particularly postoperative complications. Two independent reviewers critically appraised the studies and extracted data. Meta-analyses were performed using a random-effects model with ORs calculated for dichotomous outcomes and mean differences (MDs) for continuous outcomes. RESULTS Ten RCTs comprising 930 patients were included. Perioperative steroid administration significantly reduced the overall postoperative complication rate (OR 0.61, 95 per cent c.i. 0.43 to 0.87; P = 0.006; I2 = 26 per cent). No significant differences were shown for individual complications. Several postoperative laboratory parameters were positively affected, like total serum bilirubin (MD -0.46; 95 per cent c.i. -0.74 to -0.18; P = 0.001; I2 = 80 per cent), interleukin 6 (MD -48.99; 95 per cent c.i. -60.72 to -37.27; P < 0.001; I2 = 0 per cent) and C-reactive protein (MD -5.20; 95 per cent c.i. -7.62 to -2.77; P < 0.001; I2 = 71 per cent). There were no signs of an increase in potential steroid-induced adverse events, namely infectious complications, thromboembolic events, or bleeding. CONCLUSIONS Perioperative steroid administration significantly reduces the overall complication rate after elective liver resection without an increased risk of adverse effects.
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Affiliation(s)
- Laila Jötten
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
| | - Kira C Steinkraus
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
| | - Benno Traub
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
| | - Sandra Graf
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
| | - André L Mihaljevic
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
| | - Marko Kornmann
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
| | | | - Felix J Hüttner
- Correspondence to: Felix J. Hüttner, Department of General and Visceral Surgery, Ulm University Hospital, Albert-Einstein-Allee 23, 89081 Ulm, Germany (e-mail: )
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10
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Aziz H, Kwon YIC, Alvi S, Ahmad S, Ganguli S, Goodman M, Kwon YK. Does Chronic Use of Steroids Affect Outcomes After Liver Resection? Analysis of a National Database. J Gastrointest Surg 2022; 26:2093-2100. [PMID: 35776295 DOI: 10.1007/s11605-022-05393-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/04/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION With the increasing age of patients, more patients on chronic preoperative steroids are undergoing liver resections. Our study aimed to assess the relationship between preoperative steroids and outcomes. METHODS We performed a retrospective review of the 2014-2019 NSQIP database of all patients undergoing liver resections. Propensity score matching was utilized to match the two groups (chronic steroids vs. no steroids) based on demographics, preoperative laboratory data, and operative findings. The primary outcome measure was mortality. RESULTS There were 712 patients in the chronic steroid group and 21,751 in the no steroid group. After propensity score matching; there were 420 patients in both groups. Post-match analysis again demonstrated that patients on chronic steroids were at higher risk of cardiac arrest than those not on steroids (OR 2.01, 95% CI 1.02-2.45, p = 0.04). In addition, rates of organ space wound infection (OR 2.66, CI 1.33-5.38, p = 0.03), superficial wound infection (OR 2.79, CI 1.08-5.41, p = 0.035), renal insufficiency (OR 1.25, CI 1.03-1.62, p = 0.02), postoperative sepsis (OR 1.28, CI 1.08-1.82, p = 0.04), DVT (OR 1.7, CI 1.01-2.82, p = 0.04), and bile leakage (OR 1.75, CI 1.24-3.36, p = 0.04) were also increased in patients on steroids. However, the matched cohorts were similar in postoperative mortality rates (OR 0.11, CI 0.6-1.17, p = 0.72). CONCLUSION The study found higher morbidity rates in patients undergoing liver resections on chronic preoperative steroids but no differences in mortality.
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Affiliation(s)
- Hassan Aziz
- Division of Transplant and Hepatobiliary Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St., Boston, MA, USA.
| | - Ye In Christopher Kwon
- Division of Transplant and Hepatobiliary Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St., Boston, MA, USA
| | - Saba Alvi
- Division of Transplant and Hepatobiliary Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St., Boston, MA, USA
| | - Shahzaib Ahmad
- Division of Transplant and Hepatobiliary Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St., Boston, MA, USA
| | - Sangrag Ganguli
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Martin Goodman
- Division of Transplant and Hepatobiliary Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St., Boston, MA, USA
| | - Yong K Kwon
- Division of Transplant and Hepatobiliary Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
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Zhang DL, Chen S, Lin YC, Ye W, Li K, Wu SS. Ultrasound-guided thermal ablation versus laparoscopic surgery for focal nodular hyperplasia of the liver: A retrospective controlled study. Front Oncol 2022; 12:932889. [PMID: 35992804 PMCID: PMC9386309 DOI: 10.3389/fonc.2022.932889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose This study aims to evaluate the value of the clinical application of ultrasound-guided percutaneous thermal ablation in focal nodular hyperplasia (FNH) by comparing its safety, effectiveness, and patient experience to surgery in the treatment of hepatic FNH ≤5 cm. Method This retrospective study enrolled 82 patients with hepatic FNH having a maximum diameter of ≤5 cm, confirmed by postoperative pathologic diagnosis or needle biopsy, who underwent thermal ablation or surgery between January 2019 and September 2021. Postoperative efficacy, surgical trauma (operation time, intraoperative bleeding volume, liver function, and lost volume of normal liver tissue), postoperative complications (postoperative infection, pleural effusion, and liver dysfunction), patient experience (degree and time of postoperative pain, postoperative fasting time, indwelling thoracic chest drain, and scar size), and economic indices (postoperative hospitalization and total charges) were compared between both groups. Result No significant difference existed in postoperative efficacy between both groups (p > 0.05). No recurrent or new lesions were observed during the 6-month follow-up in both groups. However, significant differences were observed in operation time, intraoperative bleeding volume, and lost volume of normal liver tissue (p < 0.05), with significantly less trauma in the thermal ablation group. No statistically significant differences in ALT, AST, and Hb existed between both groups (p > 0.05); however, albumin was higher in the ablation group compared to the surgery group (38.21 ± 3.32 vs. 34.84 ± 3.71 g/L, p < 0.05), and WBC were lower in the ablation group (11.91 ± 3.37 vs. 13.94 ± 3.65/L, p < 0.05). The incidence of postoperative complications in the ablation group was significantly lower than that in the surgery group (p < 0.05). Patient experiences were significantly better than in the surgical group (p < 0.05), with economic indicators being significantly less in the ablation group (p < 0.05). Conclusion Ultrasound-guided percutaneous thermal ablation can treat hepatic FNH ≤5 cm with similar clinical efficacy as surgery and is an economical, safe, and minimally invasive treatment method worthy of recommendation.
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Affiliation(s)
- Dan-ling Zhang
- Department of Ultrasonography, Fuzhou No.7 Hospital, Shengli Clinical College of Fujian Medical University, Fuzhou, China
| | - Sheng Chen
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical College of Fujian Medical University, Fuzhou, China
| | - Yu-cheng Lin
- Department of Ultrasonography, Affiliated Fuzhou First Hospital of Fujian Medical, Shengli Clinical College of Fujian Medical University, Fuzhou, China
| | - Wenxin Ye
- Department of Ultrasonography, Sanming Second Hospital, Shengli Clinical college of Fujian Medical University, Sanming, China
| | - Kai Li
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- *Correspondence: Song-song Wu, ; Kai Li,
| | - Song-song Wu
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical College of Fujian Medical University, Fuzhou, China
- *Correspondence: Song-song Wu, ; Kai Li,
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Peng JS, Gusani NJ. Inflammation in Hepatocellular Carcinoma Patients Undergoing Hepatectomy: An Important Target for Ongoing Study : Editorial Comment on "The Impact of Histological Liver Inflammation on Oncology and the Prognosis of Patients Undergoing Hepatectomy for Hepatocellular Carcinoma". Ann Surg Oncol 2022; 29:2148-2149. [PMID: 35119547 DOI: 10.1245/s10434-022-11334-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 11/18/2022]
Affiliation(s)
- June S Peng
- Division of Surgical Oncology, Department of Surgery, Penn State College of Medicine, Hershey, PA, USA
| | - Niraj J Gusani
- Section of Surgical Oncology, Baptist MD Anderson Cancer Center, Jacksonville, FL, 32207, USA.
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