Effect of N-acetylcysteine on liver recovery after resection: A randomized clinical trial.
OBJECTIVE
Liver failure following hepatic resection is a multifactorial complication. In experimental studies, infusion of N-acetylcysteine (NAC) can minimize hepatic parenchymal injury.


METHODS
Patients undergoing liver resection were randomized to postoperative care with or without NAC. No blinding was performed. Overall complication rate was the primary outcome; liver failure, length of stay, and mortality were secondary outcomes. Due to safety concerns, a premature multivariate analysis was performed and included within the model randomization to NAC, preoperative ASA, extent of resection, and intraoperative vascular occlusion as factors.


RESULTS
Two hundred and six patients were randomized (110 to conventional therapy; 96 to NAC). No significant differences were noted in overall complications (32.7% and 45.7%, P = 0.06) or hepatic failure (3.6% and 5.4%, P = 0.537) between treatment groups. There was significantly more delirium within the NAC group (2.7% and 9.8%, P < 0.05) that caused early trial termination. In multivariate analysis, only randomization to NAC (OR = 2.21, 95%CI = 1.16-4.19) and extensive resections (OR = 2.28, 95%CI = 1.22-4.29) were predictive of postoperative complications.


CONCLUSIONS
Patients randomized to postoperative NAC received no benefit. There was a trend toward a higher rate of overall complications and a significantly higher rate of delirium in the NAC group. J. Surg. Oncol. 2016;114:446-450. © 2016 Wiley Periodicals, Inc.
Providence Portland Medical Center, Portland, Oregon.
Jan
J
Grendar
CHU-Pavillon Hopital de l'Enfant-Jesus, Quebec City, Quebec, Canada.
Jean F
JF
Ouellet
Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
Andrew
A
McKay
Division of General Surgery, University of Calgary, Calgary, Alberta, Canada.
Francis R
FR
Sutherland
Division of General Surgery, University of Calgary, Calgary, Alberta, Canada.
Oliver F
OF
Bathe
Division of General Surgery, University of Calgary, Calgary, Alberta, Canada.
Chad G
CG
Ball
Division of General Surgery, University of Calgary, Calgary, Alberta, Canada.
Elijah
E
Dixon
D000111:Acetylcysteine / Q000494:pharmacology*; D000368:Aged; D003693:Delirium / Q000453:epidemiology; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D017093:Liver Failure / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies
D000111:Acetylcysteine
hepatectomy; liver failure; postoperative complications