Perioperative use of selective serotonin reuptake inhibitors is associated to poor postoperative outcome in patients undergoing liver resection

Abstract

Presenter: Patrick Starlinger MD | Mayo Clinic, Rochester Background: Recently, modification of intra-platelet serotonin levels as therapeutic intervention to promote postoperative liver regeneration was proposed. In this context, we previously showed a bivalent effect of serotonin on liver regeneration and early tumour recurrence. We were able to provide exploratory data on the use of selective serotonin reuptake inhibitors (SSRI) within the previous publications. Yet, this data has to be considered exploratory, as the number of patients under SSRI treatment was extremely low. Accordingly, we aimed to evaluate the use of selective serotonin reuptake inhibitors (SSRI) in a large cohort of patients undergoing liver resection. Methods: In total, 755 patients undergoing liver resection were retrospectively included from our prospectively maintained institutional database. Perioperative intake of SSRI was evaluated and patients were followed up for postoperative liver dysfunction (LD) and morbidity. Results: Within this cohort 75 patients (9.9%) with perioperative SSRI therapy could be identified. Of note, patients treated with SSRI showed a higher incidence of severe morbidity (22.9% - no SSRI vs 31.6% - SSRI, p<0.05) and a significantly increased incidence of liver dysfunction (10.7% - no SSRI vs 23.4% - SSRI, p<0.05). On the other hand, patients receiving SSRI therapy were found to suffer from significantly reduced early tumor recurrences at 6 and 12 months after surgery (6 months: 13.0% - no SSRI vs 22.7% - SSRI, p<0.05; 12 months: 26.3% - no SSRI vs 42.1% - SSRI, p<0.05). Conclusion: Within the present study we present solid data on the influence of SSRI on postoperative clinical outcome. Indeed, perioperative SSRI treatment seems to be associated to development of LD most likely via downregulation of intra-platelet serotonin, which was shown to be central for postoperative liver regeneration. However, SSRI therapy also seems to supressearly tumor recurrences and might therefore reflect an attractive adjuvant therapy in patients after liver resection.