Glucocorticoid use and ischemia‐reperfusion injury in laparoscopic liver resection: Randomized controlled trial
Abstract Aim Laparoscopic liver resection (LLR) is increasingly carried out worldwide. However, there are concerns regarding ischemia‐reperfusion injury caused by pneumoperitoneum and the Pringle maneuver. It is not clear whether perioperative use of glucocorticoids lowers the risk of ischemia‐reper...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Annals of Gastroenterological Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ags3.12298 |
| _version_ | 1818409628702081024 |
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| author | Yasushi Hasegawa Hiroyuki Nitta Takeshi Takahara Hirokatsu Katagiri Shoji Kanno Akira Umemura Yuji Akiyama Takeshi Iwaya Koki Otsuka Akira Sasaki |
| author_facet | Yasushi Hasegawa Hiroyuki Nitta Takeshi Takahara Hirokatsu Katagiri Shoji Kanno Akira Umemura Yuji Akiyama Takeshi Iwaya Koki Otsuka Akira Sasaki |
| author_sort | Yasushi Hasegawa |
| collection | DOAJ |
| description | Abstract Aim Laparoscopic liver resection (LLR) is increasingly carried out worldwide. However, there are concerns regarding ischemia‐reperfusion injury caused by pneumoperitoneum and the Pringle maneuver. It is not clear whether perioperative use of glucocorticoids lowers the risk of ischemia‐reperfusion hepatic injury in LLR as has been reported for open liver resection. The aim of the present study was to investigate the role of perioperative glucocorticoid use in improving hepatic function and surgical outcomes after LLR. Methods In this double‐blind, randomized controlled trial (UMIN000013823), we enrolled 130 patients who presented to our institution for LLR between April 2014 and October 2018. Six patients were excluded, resulting in 124 patients being randomized to either the glucocorticoid or the control group. Preoperatively, patients in the glucocorticoid group received 500 mg methylprednisolone in saline solution, patients in the control group saline solution only. Surgical outcomes and blood parameters were compared between the two groups. Results The Pringle maneuver could not be carried out in 24 patients, resulting in 50 patients in each group being included in the analysis. Postoperatively, total, direct and indirect bilirubin, and C‐reactive protein and interleukin‐6 levels were significantly lower, albumin levels were significantly higher, and prothrombin time was significantly shorter in the glucocorticoid than in the control group. Surgical outcomes were not significantly different between the groups. Conclusion This first report on preoperative glucocorticoid use in LLR showed that it significantly improved postoperative liver function and thus might enhance the safety of LLR. |
| first_indexed | 2024-12-14T10:02:39Z |
| format | Article |
| id | doaj.art-db02a5f378ef40c6a2ee3ba69240860c |
| institution | Directory Open Access Journal |
| issn | 2475-0328 |
| language | English |
| last_indexed | 2024-12-14T10:02:39Z |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Annals of Gastroenterological Surgery |
| spelling | doaj.art-db02a5f378ef40c6a2ee3ba69240860c2022-12-21T23:07:13ZengWileyAnnals of Gastroenterological Surgery2475-03282020-01-0141768310.1002/ags3.12298Glucocorticoid use and ischemia‐reperfusion injury in laparoscopic liver resection: Randomized controlled trialYasushi Hasegawa0Hiroyuki Nitta1Takeshi Takahara2Hirokatsu Katagiri3Shoji Kanno4Akira Umemura5Yuji Akiyama6Takeshi Iwaya7Koki Otsuka8Akira Sasaki9Department of Surgery Iwate Medical University School of Medicine Morioka City JapanDepartment of Surgery Iwate Medical University School of Medicine Morioka City JapanDepartment of Surgery Iwate Medical University School of Medicine Morioka City JapanDepartment of Surgery Iwate Medical University School of Medicine Morioka City JapanDepartment of Surgery Iwate Medical University School of Medicine Morioka City JapanDepartment of Surgery Iwate Medical University School of Medicine Morioka City JapanDepartment of Surgery Iwate Medical University School of Medicine Morioka City JapanDepartment of Surgery Iwate Medical University School of Medicine Morioka City JapanDepartment of Surgery Iwate Medical University School of Medicine Morioka City JapanDepartment of Surgery Iwate Medical University School of Medicine Morioka City JapanAbstract Aim Laparoscopic liver resection (LLR) is increasingly carried out worldwide. However, there are concerns regarding ischemia‐reperfusion injury caused by pneumoperitoneum and the Pringle maneuver. It is not clear whether perioperative use of glucocorticoids lowers the risk of ischemia‐reperfusion hepatic injury in LLR as has been reported for open liver resection. The aim of the present study was to investigate the role of perioperative glucocorticoid use in improving hepatic function and surgical outcomes after LLR. Methods In this double‐blind, randomized controlled trial (UMIN000013823), we enrolled 130 patients who presented to our institution for LLR between April 2014 and October 2018. Six patients were excluded, resulting in 124 patients being randomized to either the glucocorticoid or the control group. Preoperatively, patients in the glucocorticoid group received 500 mg methylprednisolone in saline solution, patients in the control group saline solution only. Surgical outcomes and blood parameters were compared between the two groups. Results The Pringle maneuver could not be carried out in 24 patients, resulting in 50 patients in each group being included in the analysis. Postoperatively, total, direct and indirect bilirubin, and C‐reactive protein and interleukin‐6 levels were significantly lower, albumin levels were significantly higher, and prothrombin time was significantly shorter in the glucocorticoid than in the control group. Surgical outcomes were not significantly different between the groups. Conclusion This first report on preoperative glucocorticoid use in LLR showed that it significantly improved postoperative liver function and thus might enhance the safety of LLR.https://doi.org/10.1002/ags3.12298hepatectomyischemiclaparoscopyminimally invasivesteroid |
| spellingShingle | Yasushi Hasegawa Hiroyuki Nitta Takeshi Takahara Hirokatsu Katagiri Shoji Kanno Akira Umemura Yuji Akiyama Takeshi Iwaya Koki Otsuka Akira Sasaki Glucocorticoid use and ischemia‐reperfusion injury in laparoscopic liver resection: Randomized controlled trial Annals of Gastroenterological Surgery hepatectomy ischemic laparoscopy minimally invasive steroid |
| title | Glucocorticoid use and ischemia‐reperfusion injury in laparoscopic liver resection: Randomized controlled trial |
| title_full | Glucocorticoid use and ischemia‐reperfusion injury in laparoscopic liver resection: Randomized controlled trial |
| title_fullStr | Glucocorticoid use and ischemia‐reperfusion injury in laparoscopic liver resection: Randomized controlled trial |
| title_full_unstemmed | Glucocorticoid use and ischemia‐reperfusion injury in laparoscopic liver resection: Randomized controlled trial |
| title_short | Glucocorticoid use and ischemia‐reperfusion injury in laparoscopic liver resection: Randomized controlled trial |
| title_sort | glucocorticoid use and ischemia reperfusion injury in laparoscopic liver resection randomized controlled trial |
| topic | hepatectomy ischemic laparoscopy minimally invasive steroid |
| url | https://doi.org/10.1002/ags3.12298 |
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