Key result
Preoperative dexamethasone reduces major complications, hospital stays, and hepatocellular injury during HCC hepatectomy.
Why the study?
Prolonging hepatic inflow clamping time to a 25-min ischemic interval during intermittent Pringle maneuver in hepatectomy inevitably aggravates ischemia-reperfusion injury, prompting evaluation of prophylactic dexamethasone to alleviate surgical stress.
Does preoperative dexamethasone administration improve perioperative outcomes in HCC patients undergoing hepatectomy with a 25-min intermittent Pringle's maneuver?
RCT (n=270)
randomly assigned
Does preoperative dexamethasone administration improve perioperative outcomes in HCC patients undergoing hepatectomy with a 25-min intermittent Pringle's maneuver?
Preoperative dexamethasone administration reduces hepatocellular injury, inflammatory response, and major complications in HCC patients undergoing hepatectomy with a 25-min intermittent Pringle's maneuver.
Supports preoperative dexamethasone in HCC hepatectomy to cut complications and stay; extends RCT evidence for perioperative steroids in liver resection.
BACKGROUND: A previous randomized controlled trial demonstrated that intermittent Pringle's maneuver (IPM) with a 25-min ischemic interval could be applied safely and efficiently in hepatectomy for patients with hepatocellular carcinoma (HCC). But prolonging the hepatic inflow clamping time will inevitably aggravate the ischemia-reperfusion injury. Therefore, we aimed to evaluate the effect of prophylactic dexamethasone on alleviating surgical stress for HCC patients with a 25-min ischemic interval. METHODS: From December 2022 to April 2023, patients who met the inclusion criteria were randomly assigned to the dexamethasone group or control group. Perioperative data and short-term survival outcomes between the two groups were recorded and compared, and subgroup analysis was performed. RESULTS: Two hundred and seventy patients were allocated to the dexamethasone group ( n =135) and control group ( n =135). Patients in the dexamethasone group had lower area under the curve of serial alanine aminotransferase (AUC ALT ) ( P =0.043) and aspartate aminotransferase (AUC AST ) ( P =0.009), total bilirubin (TB) ( P =0.018), procalcitonin (PCT) ( P =0.012), interleukin-6 (IL-6) ( P =0.006), incidence of major complication ( P =0.031) and shorter postoperative hospital stay ( P =0.046) than those in the control group. Subgroup analysis showed that the dexamethasone group experienced milder hepatocellular injury than the control group for patients with cirrhosis, and for patients without cirrhosis, the dexamethasone group experienced milder inflammatory response. Moreover, the dexamethasone group preserved better liver function and experienced milder inflammatory response for patients undergoing major hepatectomy, although the hepatocellular injury was not significantly improved. CONCLUSION: Preoperative dexamethasone administration can help improve perioperative outcomes for HCC patients when applying IPM with a 25-min ischemic interval in hepatectomy.
No takes yet. Share an insight, caveat, or question.
Huang et al. (2023) conducted an RCT in hepatocellular carcinoma (HCC) (n=270). Preoperative dexamethasone vs. Control was evaluated on Perioperative data and short-term survival outcomes. Preoperative dexamethasone administration significantly reduced major complications (P=0.031), postoperative hospital stay (P=0.046), and hepatocellular injury in HCC patients undergoing hepatectomy.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: