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Impact of Perioperative Steroid Administration in Patients Undergoing Major Hepatectomy with Extrahepatic Bile Duct Resection: A Randomized Controlled Trial

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

To date, five randomized controlled trials have assessed the clinical benefit of perioperative steroid administration in hepatectomy; however, all of these studies involved a substantial number of ‘minor’ hepatectomies. The benefit of steroid administration for patients undergoing ‘complex’ hepatectomy, such as major hepatectomy with extrahepatic bile duct resection, is still unclear. This study aimed to evaluate the clinical benefit of perioperative steroid administration for complex major hepatectomy.

Methods

Patients with suspected hilar malignancy scheduled to undergo major hepatectomy with extrahepatic bile duct resection were randomized into either the control or steroid groups. The steroid group received hydrocortisone 500 mg immediately before hepatic pedicle clamping, followed by hydrocortisone 300 mg on postoperative day (POD) 1, 200 mg on POD 2, and 100 mg on POD 3. The control group received only physiologic saline. The primary endpoint was the incidence of postoperative liver failure.

Results

A total of 94 patients were randomized to either the control (n = 46) or steroid (n = 48) groups. The two groups had similar baseline characteristics; however, there were no significant differences between the groups in the incidence of grade B/C postoperative liver failure (control group, n = 8, 17%; steroid group, n = 4, 8%; p = 0.188) and other complications. Serum bilirubin levels on PODs 2 and 3 were significantly lower in the steroid group than those in the control group; however, these median values were within normal limits in both groups.

Conclusion

Perioperative steroid administration did not reduce the risk of postoperative complications, including liver failure following major hepatectomy with extrahepatic bile duct resection.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Shunsuke Onoe MD, Yukihiro Yokoyama MD, Tomoki Ebata MD, Tsuyoshi Igami MD, Takashi Mizuno MD, Junpei Yamaguchi MD, Nobuyuki Watanabe MD & Masato Nagino MD

  2. Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Shogo Suzuki MD & Kimitoshi Nishiwaki MD

  3. Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan

    Masahiko Ando MD

Authors
  1. Shunsuke Onoe MD
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  2. Yukihiro Yokoyama MD
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  3. Tomoki Ebata MD
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  4. Tsuyoshi Igami MD
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  6. Junpei Yamaguchi MD
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  9. Kimitoshi Nishiwaki MD
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  10. Masahiko Ando MD
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  11. Masato Nagino MD
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Corresponding author

Correspondence to Masato Nagino MD.

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Disclosure

Shunsuke Onoe, Yukihiro Yokoyama, Tomoki Ebata, Tsuyoshi Igami, Takashi Mizuno, Junpei Yamaguchi, Nobuyuki Watanabe, Shogo Suzuki, Kimitoshi Nishiwaki, Masahiko Ando, and Masato Nagino declare there are no potential conflicts of interest.

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Onoe, S., Yokoyama, Y., Ebata, T. et al. Impact of Perioperative Steroid Administration in Patients Undergoing Major Hepatectomy with Extrahepatic Bile Duct Resection: A Randomized Controlled Trial. Ann Surg Oncol 28, 121–130 (2021). https://doi.org/10.1245/s10434-020-08745-7

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  • DOI: https://doi.org/10.1245/s10434-020-08745-7

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