Metalloproteinase expression after desflurane preconditioning in hepatectomies: A randomized clinical trial

Table 1 Patients’ characteristics

Characteristics	Desflurane group, n = 23	Control group, n = 23	P value
Age, yr	64.5 ± 10.6	61.5 ± 11,4	0.612
Males	12 (52.1)	14 (60.8)	0.719
ΒΜΙ, kg/m2	25.6 ± 5.1	26.2 ± 4.8	0.953
Cause of liver resection			0.914
Hepatic cancer	10 (44)	9 (39)
Liver metastasis	9 (39)	11 (48)
Hemangioma	1 (4.3)	1 (4.3)
Klatskin tumor	2 (8.6)	1 (4.3)
Focal nodular hyperplasia	1 (4.4)	1 (4.3)
No of tumors			0.772
Solitary	14 (60.9)	12 (52.2)
2	5 (21.7)	7 (30.4)
3	3 (13)	4 (17.4)
4	1 (4.3)	0
Size of largest tumor, cm	12.5 ± 8.7	11.9 ± 7.5	0.711
No of segments			1
1	10 (43.5)	11 (47.8)
2-3	8 (34.6)	7 (30.4)
> 3	5 (21.7)	5 (21.7)
Type of hepatectomy			0.853
Right extended	3 (13)	2 (8.6)
Right	8 (34.7)	10 (43.5)
Left	10 (43.5)	8 (34.7)
Left extended	2 (8.6)	3 (13)
Previous treatment status			0.552
No preoperative treatment	14 (60.9)	12 (52.2)
Neo-adjuvant chemotherapy	9 (39.1)	11 (47.8)
Intraoperative blood loss, mL	630 ± 550	690 ± 580	0.847
Intraoperative blood transfusion, units of red blood cells			0.875
0	5 (21.7)	5 (21.7)
1	6 (26)	7 (30.4)
2	8 (34.7)	7 (30.4)
3	3 (13)	2 (8.6)
4	1 (4.3)	2 (8.6)

Quantitative variables are expressed as mean and standard deviation, while qualitative variables are expressed as absolute (n) and relative values (%). The t-test was used for comparison of patient's age between the two groups. The χ² test was used for sex (male). Fisher’s exact test was used for etiologies of hepatectomy, type of hepatectomy, and intraoperative transfusion. BMI: Body mass index.

Table 2 Postoperative complications, n (%)

Postoperative complications	Desflurane group, n = 23	Control group, n = 23	P value
Postoperative blood transfusion (red blood cells)			0.555
0 U	13 (56.5)	11 (47.8)
1 U	10 (43.5)	10 (43.5)
2 U	0	2 (8.7)
Bile leak	2 (8.7)	2 (8.7)	1.00
Deep vein thrombosis	2 (8.7)	1 (4.3)	0.555
Pneumonia	4 (17.4)	5 (21.7)	0.71

Variables are expressed as absolute and relative values (%). Fisher’s exact test was used for comparisons between the two groups.

Table 3 Matrix metalloproteinases and tissue inhibitors of metalloproteinases in the different groups

	Groups		P (95%CI)
MMP2	Desflurane	80.6 ± 42.3	a(-46.4 to 3.1)
	Control	123.5 ± 51.7
MMP9	Desflurane	178.5 ± 80.3	b(-473.9 to 203.1)
	Control	449.9 ± 298.8
TIMP1	Desflurane	173.3 ± 87.6	b(25.9 to 104.3)
	Control	104.4 ± 39.7
TIMP2	Desflurane	154.4 ± 65.4	b(35.7 to 93.6)
	Control	90.6 ± 29.3

^aP < 0.05 statistical significance vs intervention group.

^bP < 0.01 statistical significance vs intervention group. Results are expressed as means and standard deviation. The t-test was used for between-groups comparisons, resulting in P values and 95% confidence intervals (CIs, in brackets). MMP: Matrix metalloproteinase; TIMP: Tissue inhibitors of metalloproteinase; CI: Confidence interval.

Table 4 Histological findings between the different groups, n (%)

Score	Desflurane group, n = 23	Control group, n = 23	P value
Neutrophil infiltration
0	9 (39)	NA	b
1	9 (39)	5 (23)
2	5 (23)	9 (39)
3	NA	9 (39)
Fibrosis
0	11 (48)	7 (30)	0.767
1	7 (30)	9 (39)
2	3 (13)	4 (18)
3	2 (9)	3 (13)
Steatosis
0	11 (48)	9 (39)	0.780
1	10 (43)	10 (43)
2	2 (9)	4 (18)
3

^aP < 0.05 statistical significance vs intervention group.

^bP < 0.01 statistical significance vs intervention group. Results are expressed as absolute and relative values. The χ² test or Fisher’s exact test was used for comparisons between the groups. NA: Not available.

Table 5 Relative changes between baseline and postoperative values in the two groups

Change, %	AT III	P (95%CI)	PC	P (95%CI)	INR	P (95%CI)
Day 1		a(4.6 to 15.4)		a(2.2 to 13.5)		a(-22.6 to -7.5)
Desflurane	-17.9 ± 16.7		-11.9 ± 13.2		12.5 ± 17.1
Control	-27.9 ± 14.9		-20.9 ± 16.1		27.5 ± 13.6
Day 2		a(5.3 to 18.5)		b(9.7 to 18.1)		b(-39.5 to -11.7)
Desflurane	-15.4 ± 16.6		-8.2 ± 10.1		14.5 ± 20.1
Control	-27.3 ± 18.9		-22.1 ± 16.5		40.1 ± 31.1
Day 3		b(14.3 to 23.7)		b(10.2 to 18.9)		a(-27.6 to -4.2)
Desflurane	-12.1 ± 16.6		-8.3 ± 11.9		17.9 ± 15.6
Control	-31.1 ± 28.2		-22.9 ± 15.7		33.6 ± 28.2
Day 4		a(10.9 to 18.2)		a(5.6 to 15.5)		a(-26.8 to -4.1)
Desflurane	-12.3 ± 19.8		-1.4 ± 14.8		14.4 ± 20.1
Control	-23.7 ± 16.2		-11.9 ± 15.4		29.8 ±23.6
Day 5		b(9.8 to 22.7)		a(2.5 to 14.3)		a(-23.7 to -2.2)
Desflurane	-3.8 ± 17.7		3.3 ± 13.6		7.7 ± 18.7
Control	-12.4 ± 17.4		-5.5 ±11.5		22.2 ± 17.8

^aP < 0.05 statistical significance vs intervention group.

^bP < 0.01 statistical significance vs intervention group. AT III: Antithrombin III; CI: Confidence interval; INR: International normalized ratio; PC: Protein C.

Table 6 Postoperative course of coagulation and inflammation laboratory indices

Day	Group	WBCs (103/μL)	SGOT (U/L)	SGPT (U/L)	γ-GT (U/L)	Tbil (mg/dL)	Fib (g/L)	Plts (109/L)	D-dimer (μg/mL)	Protein S (%)	aPTT (s)
0	Control	6.1 ± 1.6	30 ± 13	44 ± 30	47 ± 26	0.78 ± 0.45	2.4 ± 0.5	229.2 ± 78	0.57 ± 0.3	83.5 ± 12	26 ± 1.4
	Desflurane	5.8 ± 1.8	29 ± 10	38 ± 33	39 ± 24	0.72 ± 0.36	2.4 ± 0.4	202.5 ± 92	0.55 ± 0.3	84.1 ± 14	26.2 ± 1.6
P		> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05
1	Control	8 ± 2	32 ± 16	44 ± 32	50 ± 24	0.88 ± 0.48	3.6 ± 1	126.1 ± 32	3.8 ± 1.4	60.8 ± 11	28 ± 2
	Desflurane	6 ± 1.8	26 ± 10	39 ± 23	37 ± 22	0.69 ± 0.38	2.7 ± 0.6	168.3 ± 86	2.6 ± 1.3	64.8 ± 16	27.8 ± 3
P		b	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05
2	Control	11.6 ± 6.4	395 ± 256	373 ± 263	113 ± 96	1.91 ± 0.94	3.2 ± 0.8	130.5 ± 29	4.1 ± 0.9	60 ± 12	31 ± 4.8
	Desflurane	9.2 ± 4.7	197 ± 83	227 ± 170	140 ± 109	1.65 ± 0.83	2.9 ± 0.5	160.2 ± 81	3.7 ± 1.1	65.4 ± 14	28 ± 3.9
P		a	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05
3	Control	12.5 ± 3.8	543 ± 395	395 ± 326	129 ± 106	2.29 ± 1.22	2.9 ± 0.7	137.8 ± 89	4.2 ± 2.3	59.9 ± 13	29.5 ± 3.7
	Desflurane	10.1 ± 2	256 ± 140	197 ± 83	131 ± 70	2.4 ± 1.72	3.06 ± 0.6	146.2 ± 54	4.9 ± 3.1	66.6 ± 14	27.2 ± 2.5
P		b	a	a	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05
4	Control	11.7 ± 2.9	187 ± 109	304 ± 236	124 ± 107	1.31 ± 0.72	3 ± 0.4	166.4 ± 51	3.9 ± 1.4	67 ± 12	28 ± 2.6
	Desflurane	9.9 ± 2.1	137 ± 102	177 ± 106	101 ± 93	1.6 ± 1.1	3.5 ± 0.9	157.2 ± 41	4.1 ± 1.1	77 ± 14	26 ± 2.7
P		b	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05
5	Control	9.5 ± 2.8	105 ± 89	135 ± 81	120 ± 73	0.88 ± 0.48	3.2 ± 0.5	186.3 ± 31	3.2 ± 1.6	85 ± 11	26.7 ± 3
	Desflurane	8.2 ± 2	84 ± 71	162 ± 91	92 ± 66	0.69 ± 0.38	4.1 ± 0.6	176.5 ± 76	3.6 ± 1.6	87 ± 16	25.9 ± 3
P		a	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	> 0.05

^aP < 0.05 statistical significance vs intervention group.

^bP < 0.01 statistical significance vs intervention group. WBCs: White blood cells; SGOT: Serum glutamic oxaloacetic transaminase; SGPT: Serum glutamic pyruvic transaminase; γ-Gt: Gamma-glutamyl transferase; Tbil: Total bilirubin; Fib: Fibrinogen; Plts: Platelets; aPTT: Activated partial thromboplastin time.