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Journal of Hepato-Biliary-Pancreatic Surgery

, Volume 14, Issue 5, pp 484–492 | Cite as

Preoperative high-dose steroid administration attenuates the surgical stress response following liver resection: results of a prospective randomized study

  • Sven C. Schmidt
  • Susanne Hamann
  • Jan M. Langrehr
  • Conny Höflich
  • Jens Mittler
  • Dictmar Jacob
  • Peter Neuhaus
Original articles

Abstract

Background/Purpose

Major abdominal surgery such as liver resection is associated with an excessive hyperinflammatory response and transient immunosuppression. We investigated the immunomodulating effect of preoperative pulse administration of high-dose methylprednisolone in patients undergoing hepatic resection without pedicle clamping.

Methods

Twenty patients who underwent hepatic resection were randomized into two groups: a steroid group (n = 10), in which patients were given 30 mg/kg per body weight (BW) methylprednisolone intravenously, and a control group (n = 10), in which patients received a placebo (sodium chloride) infusion. The main outcome parameter to assess systemic stress was the serum plasma level of interleukin-6 (IL-6). To evaluate cell-mediated immune function, human leukocyte antigen-DR (HLA-DR) expression on peripheral blood monocytes and lipopolysaccharide (LPS)-induced tumor necrosis factor-α (TNF-α) release by peripheral monocytes was measured. Other investigated serum parameters included C-reactive protein (CRP), total bilirubin, alanine aminotransferase (ALT), prothrombin time (PT)-INR, and cytokines such as IL-8 and IL-10 and TNF-α. Postoperative convalescence, complication rate, and length of hospital stay were compared between the groups.

Results

Postoperative plasma concentrations of IL-6 (days 1 and 2), IL-8 (days 2 and 3), and CRP (days 1–4) were significantly lower in the steroid than in the control group. The total bilirubin concentration was significantly lower on day 6 in the steroid than in the control group. Four hours after surgery, LPS-induced TNF-α secretion was significantly reduced in the steroid group, but it increased rapidly during the following days. HLA-DR, ALT, and PT-INR levels were not different between the two groups. The postoperative hospital stay in the steroid group was significantly lower compared to that in the control group (mean, 10.5 days versus 14.8 days; P < 0.05). No differences were found in the convalescence score or postoperative complication rate.

Conclusions

Intravenous methylprednisolone administration before hepatic resection significantly reduced systemic inflammatory cytokine release. No adverse effect on immunity was noted due to the methylprednisolone. We found no significant difference in the convalescence score, but a significantly shorter hospital stay in the steroid group. Further studies with more patients are needed to elucidate the clinical impact of preoperative steroid bolus therapy in liver surgery.

Keywords

Liver Resection Hepatic Resection Liver Regeneration Steroid Administration Pringle Maneuver 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Tokyo 2007

Authors and Affiliations

  • Sven C. Schmidt
    • 1
  • Susanne Hamann
    • 1
  • Jan M. Langrehr
    • 1
  • Conny Höflich
    • 2
  • Jens Mittler
    • 1
  • Dictmar Jacob
    • 1
  • Peter Neuhaus
    • 1
  1. 1.Department of General-, Visceral- and Transplantation SurgeryUniversity Medicine Berlin, Charité Campus Virchow ClinicBerlinGermany
  2. 2.Institute of Medical ImmunologyUniversity Medicine Berlin, Charité Campus MitteBerlinGermany

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