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Impact of Pre-operative Single-dose Methylprednisolone on Outcomes After Major Hepatectomy in Adults: A Prospective,
Muddada Vivekananda1, Guhan Venkatakrishnan1, Binoj S P Thankamony Amma1
1Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Amrita University, Kochi, Kerala, India.
Background/Aim:
The impact of a single preoperative steroid dose on inflammatory modulation and clinical outcomes in major hepatectomy remains uncertain. The aim of this study was to assess the influence of intraoperative administration of a single dose of steroids on postoperative morbidity and mortality in patients undergoing major hepatectomies.
Methods:
In this investigator-blinded, randomised trial, 124 patients scheduled for major hepatectomy (including 79 living-donor hepatectomies and 60 minimally invasive procedures) were allocated to either the steroid-administered group (500 mg methylprednisolone administered intravenously at induction of anaesthesia) or the control group (no steroids). Use of the Pringle manoeuvre during parenchymal transection was at the surgeon's discretion. The primary endpoint measured was postoperative complications as classified by the Clavien-Dindo system. Secondary endpoints included assessment of postoperative liver function (total bilirubin, aspartate transaminase [AST], alanine transaminase [ALT], and international normalised ratio on postoperative days 1, 3, and 5, and peak values), C-reactive protein (CRP), readmission rates, and postoperative mortality.
Results:
Both groups showed comparable rates of Pringle manoeuvre application (62% steroids vs 52% control) and duration (30 min each). The number of patients experiencing complications did not differ significantly between groups (12 [24%] steroids vs 18 [32%] control; P = 0.353) although the absolute number of Clavien-Dindo complications was significantly lower in the steroid-administered group (12 [26%] vs 26 [46.4%]; P = 0.03), recognising that individual patients could have multiple complications. The observed reduction was primarily attributed to fewer surgical site infections in the steroid cohort. Peak bilirubin, ALT, and AST levels were similar across groups. Day 5 CRP was significantly low in steroids group (28 vs 58, P value-0.004). Readmission rates and mortality were equivalent between cohorts.A subgroup analysis examining Pringle manoeuvre application revealed comparable complication rates (steroids: 19.4% vs control: 30%; P = 0.334). Furthermore, peak AST (274 vs 323; P = 0.05) and day 5 CRP (29 vs 61; P = 0.003) were markedly lower among those receiving steroids.
Conclusion:
Administration of preoperative steroids during major hepatectomy attenuated the postoperative inflammatory response but did not significantly reduce overall postoperative complications.
