title: Neutrophil Elastase Inhibitor Following Liver Resection: A Matched Cohort Study.
abstract: BACKGROUND
  Sivelestat is a neutrophil elastase inhibitor (NEI) with positive impact on the respiratory complications in thoracic surgery. Based on the findings of a recent study, NEI may have a good response for avoiding ischemia reperfusion injury in liver resection.
  
  
  OBJECTIVE
  The current study aimed to examine the impact of NEI on the postoperative outcomes after liver resection.
  
  
  METHODS
  The data were collected from 374 consecutive patients scheduled to undergo liver resection. Seven perioperative variables were matched on the basis of the patients' background. Then, the NEI (n = 61) and control (n = 61) groups were compared. NEI was administered at a dose of 0.2 mg/kg/h for three days from the postoperative day 0 (POD0). The liver function, coagulation activity, inflammatory response, respiratory complications, and overall complications were compared.
  
  
  RESULTS
  The levels of serum interleukin-6 (NEI group: 113 pg/mL [26.9 - 522.0] vs. control group: 174 [28.6 - 1040.6], P < 0.01) and C-reactive protein (CRP) (2.9 IU/L [range: 0.1 - 8.6] vs. 4.11 [0.3 - 13.8], P = 0.01) on the first postoperative day (POD1) and the alveolar-arterial oxygen tension difference (32.3 Torr [-28.6 - 132.3] vs. 46.6 [-11.2 - 251.6], P = 0.04) on the third postoperative day (POD3) were significantly lower in the NEI group than the control group. The rate of pleural effusion was significantly lower in the NEI group compared to that of the control group [13 patients (21.3%) vs. 23 (37.7%), P = 0.04]. However, the coagulation activities (P = 0.68), liver function (P = 0.69), non-respiratory complications (P = 0.84), and overall complications (P = 0.71) did not differ significantly between the groups.
  
  
  CONCLUSIONS
  Intravenous NEI administration had positive impact on the postoperative inflammatory response and oxygenation while it did not affect either coagulation or the liver function, as well as severe grade complications following resection.
authors.affiliation: Department of Digestive Surgery, School of Medicine, Nihon University, Tokyo, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Yamazaki
authors.affiliation: Department of Digestive Surgery, School of Medicine, Nihon University, Tokyo, Japan.
authors.forename: Tadatoshi
authors.initials: T
authors.lastname: Takayama
authors.affiliation: Department of Digestive Surgery, School of Medicine, Nihon University, Tokyo, Japan.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Moriguchi
authors.affiliation: Department of Digestive Surgery, School of Medicine, Nihon University, Tokyo, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Department of Digestive Surgery, School of Medicine, Nihon University, Tokyo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Mitsuka
authors.affiliation: Department of Digestive Surgery, School of Medicine, Nihon University, Tokyo, Japan.
authors.forename: Nao
authors.initials: N
authors.lastname: Yoshida
authors.affiliation: Department of Digestive Surgery, School of Medicine, Nihon University, Tokyo, Japan.
authors.forename: Tokio
authors.initials: T
authors.lastname: Higaki
keywords: Complication; Liver Resection; Neutrophil Elastase Inhibitor
references.citation: J Gastroenterol Hepatol. 2007 Jun;22(6):837-40
references.pmid: 17565638
references.citation: J Surg Res. 2009 Aug;155(2):311-7
references.pmid: 19482311
references.citation: World J Surg. 2012 May;36(5):1122-7
references.pmid: 22366983
references.citation: Br J Surg. 2012 Nov;99(11):1584-90
references.pmid: 23027077
references.citation: Langenbecks Arch Surg. 2007 Jan;392(1):45-54
references.pmid: 16983576
references.citation: Crit Care Med. 2004 Aug;32(8):1695-702
references.pmid: 15286546
references.citation: Eur J Pharmacol. 2004 Mar 19;488(1-3):173-80
references.pmid: 15044049
references.citation: Shock. 2007 Oct;28(4):401-5
references.pmid: 17577134
references.citation: Crit Care Med. 2002 May;30(5 Suppl):S281-7
references.pmid: 12004249
references.citation: Ann Surg. 2011 Jan;253(1):50-5
references.pmid: 21233606
references.citation: Arch Surg. 2011 Nov;146(11):1293-9
references.pmid: 22106322
references.citation: J Surg Res. 2013 Mar;180(1):e31-6
references.pmid: 22595015
references.citation: Dis Esophagus. 2007;20(6):478-86
references.pmid: 17958722
references.citation: Thorac Cardiovasc Surg. 2006 Sep;54(6):404-7
references.pmid: 16967377
references.citation: Interact Cardiovasc Thorac Surg. 2009 Jun;8(6):629-34
references.pmid: 19279053
references.citation: Br J Surg. 2003 Mar;90(3):302-5
references.pmid: 12594664
references.citation: Surg Today. 2006;36(4):321-6
references.pmid: 16554988
references.citation: World J Surg. 2007 Oct;31(10 ):1996-2001
references.pmid: 17674097
references.citation: Transplantation. 2010 May 15;89(9):1050-6
references.pmid: 20160675
references.citation: Transpl Int. 2003 May;16(5):341-6
references.pmid: 12759726
references.citation: Br J Surg. 2007 May;94(5):609-19
references.pmid: 17315175
references.citation: Semin Surg Oncol. 1993 Jul-Aug;9(4):298-304
references.pmid: 8210909
references.citation: Brain Res. 2009 Mar 9;1259:98-106
references.pmid: 19168036
references.citation: Anesthesiology. 1997 Sep;87(3):635-41
references.pmid: 9316970
references.citation: Int Arch Allergy Immunol. 1997 Mar;112(3):262-9
references.pmid: 9066513