title: Validation of perioperative steroids administration in liver resection: a randomized controlled trial.
abstract: OBJECTIVE
  We performed a randomized controlled trial to investigate the clinical benefits of perioperative treatment with steroids in patients undergoing liver resection.
  
  
  BACKGROUND
  Perioperative steroids are considered to reduce surgical stress, but evidence supporting proposed clinical benefits is largely anecdotal.
  
  
  METHODS
  The 210 patients scheduled to undergo liver resection were randomly assigned to a steroids group (n = 105) or a control group (n = 105). The steroids group received 500 mg hydrocortisone immediately before hepatic-pedicle clamping, followed by 300 mg hydrocortisone on postoperative day (POD) 1, 200 mg on POD 2, and 100 mg on POD 3. Serum levels of total bilirubin, aminotransferases coagulation factors, and inflammatory-related cytokines, and the clinical course were compared between the 2 groups. The primary end point was the postoperative bilirubin level.
  
  
  RESULTS
  All 210 patients underwent radical liver resection with no operative mortality. The median bilirubin level on POD 2 was significantly lower in the steroids group [0.71 mg/dL (0.33-2.17)] than in the control group [1.03 mg/dl (0.39-3.57); P = 0.01]. The postoperative time courses of the bilirubin level (P = 0.01), the interleukin-6 level (P = 0.01) and the C-reactive protein level (P = 0.01) were significantly lower whereas the the prothrombin level (P = 0.01) and interleukin-10 level (P = 0.01) were significantly higher in the steroids group. There was no difference between the groups in the proportion of patients with complications (40% vs 43%; P = 0.66) or the length of the hospital stay (14 days vs 13 days; P = 0.68).
  
  
  CONCLUSIONS
  Perioperative treatment with steroids has a positive impact on the liver function of patients who undergo liver resection, without increasing the risk of complications.
authors.affiliation: Department of Digestive Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Tadatoshi
authors.initials: T
authors.lastname: Takayama
authors.forename: Shintaro
authors.initials: S
authors.lastname: Yamazaki
authors.forename: Masamichi
authors.initials: M
authors.lastname: Moriguchi
authors.forename: Takao
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Hisashi
authors.initials: H
authors.lastname: Nakayama
authors.forename: Tokio
authors.initials: T
authors.lastname: Higaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D006498:Hepatectomy; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D007902:Length of Stay; D008107:Liver Diseases / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications; D011292:Premedication; D015203:Reproducibility of Results
chemical_list: D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone