Preoperative Single-Dose Methylprednisolone Versus Placebo For Elective Major Liver Resection In Adults: A Randomized Controlled Trial

Abstract

Presenter: Chad Ball MD, MSc | University of Calgary Background: Hepatic resections are associated with a significant acute systemic inflammatory response. This effect subsequently correlates with postoperative morbidity, mortality and length of recovery. Multiple small trials have proposed that the administration of glucocorticoids may modulate this effect. The primary aim of this study was to evaluate the efficacy of a single preoperative dose of methylprednisolone for preventing postoperative complications after major liver resections. Methods: This study was a parallel, dual-arm, double-blind randomized controlled trial. Adult patients undergoing elective major hepatic resection (>3 segments) at a quaternary care institution were included (2013-2019). Patients were randomly assigned to receive a single preoperative 500mg dose of methylprednisolone versus placebo. The main outcome measure was postoperative complications after liver resection, within 90 days of the index operation. Standard statistical methodology was employed (p<0.05 = significant). Results: A total of 151 patients who underwent a major hepatic resection were randomized (mean age = 62.8 years; 57% male; body-mas-index = 27.9). No significant differences were identified between the intervention and control groups (age, sex, body-mass-index, preoperative comorbidities, hepatic function, ASA class, portal vein embolization rate)(p>0.05). Underlying hepatic diagnoses included colorectal liver metastases (69%), hepatocellular carcinoma (18%), non-colorectal liver metastases (7%), and intrahepatic cholangiocarcinoma (6%). There was a significant reduction in the overall incidence of postoperative complications in the methylprednisolone group (31.2% vs. 47.3%; p=0.042). Patients in the glucocorticoid group also displayed less frequent organ space surgical site infections (6.5% vs. 17.6%; p=0.036), as well as a shorter length of hospital stay (8.9 vs. 12.5 days; p=0.015). Postoperative serum bilirubin and prothrombin time-international normalized ratio (PT-INR) levels were also lower in the glucocorticoid group (p=0.03 and 0.04 respectively). Multivariate analysis did not identify any additional significant modifying factor relationships (estimated blood loss, duration of surgery, hepatic vascular occlusion (rate or duration), portal vein embolization, drain use, etc.)(p>0.05). Conclusion: A single preoperative dose of methylprednisolone significantly reduces the length of hospital stay, postoperative serum bilirubin and PT-INR, as well as infectious and overall complications following major hepatectomy.