Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2021; 13(9): 1079-1094
Published online Sep 27, 2021. doi: 10.4240/wjgs.v13.i9.1079
Perioperative steroid administration reduces overall complications in patients undergoing liver resection: A meta-analysis
Hao-Han Hai, Phoebe Aw, Thomas Zheng Jie Teng, Vishal G Shelat
Hao-Han Hai, Phoebe Aw, NUS Yong Loo Lin School of Medicine, Singapore 119228, Singapore
Thomas Zheng Jie Teng, Vishal G Shelat, NTU Lee Kong Chian School of Medicine, Singapore 308232, Singapore
Vishal G Shelat, Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
Author contributions: Hai HH and Aw P performed the analysis of the results and writing of the manuscript; Teng TZJ contributed to editing the manuscript and interpreting the results; Shelat VG designed and directed the project; All authors discussed the results and commented on the manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vishal G Shelat, FRCS (Ed), FEBS, Adjunct Associate Professor, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. vgshelat@gmail.com
Received: January 26, 2021
Peer-review started: January 26, 2021
First decision: March 29, 2021
Revised: April 3, 2021
Accepted: June 16, 2021
Article in press: June 16, 2021
Published online: September 27, 2021
ARTICLE HIGHLIGHTS
Research background

Hepatic resection (HR) results in an inflammatory response that can be modified by perioperative steroid administration. However, it remains to be determined if this response's attenuation translates to a reduction in complications.

Research motivation

Stress from major surgery results in an inflammatory response secondary to cytokine and free radical release. This inflammatory response is essential for healing and restoration of physiologic function; however, it can increase morbidity, mortality, and worsen postoperative outcomes if excessive. Modifying the inflammatory response by perioperative steroid administration could improve surgical outcomes. Besides, inflammatory markers are increasingly shown to predict short-term perioperative and long-term oncologic outcomes following HR. Thus, modulation of inflammatory response to improve surgical outcomes remains an unmet need in hepatic surgery.

Research objectives

To evaluate if perioperative administration of steroids reduces complications following HR.

Research methods

A systematic review of randomized controlled trials (RCTs) was conducted on PubMed, Embase, and Cochrane Central Register of Controlled Trials to evaluate the effect of perioperative steroid (compared to placebo or no intervention) use in patients undergoing HR. Clinical outcomes were extracted, and meta-analysis was performed.

Research results

Eight RCTs including 590 patients were included. Perioperative steroid administration was associated with significant reduction in postoperative complications [odds ratios: 0.58; 95% confidence intervals (CI): (0.35, 0.97), P = 0.04]. There was also improvement in biochemical and inflammatory markers, including serum bilirubin on postoperative day 1 [MD: -0.27; 95%CI: (-0.47, -0.06), P = 0.01], C-reactive protein on postoperative day 3 [MD: -4.89; 95%CI: (-5.83, -3.95), P < 0.001], and IL-6 on postoperative day 1 [MD: -54.84; 95%CI: (-63.91, -45.76), P < 0.001].

Research conclusions

Perioperative steroids administration in HR may reduce overall complications, postoperative bilirubin, and inflammation. Further studies are needed to determine the optimal dose and duration, and patient selection.

Research perspectives

The International Study Group on Liver Surgery needs to make recommendations to standardize the perioperative use of steroids in patients undergoing HR liver resection as type, dose, and time of administration of perioperative steroids could impact clinical outcomes. Lastly, there was also a lack of long-term follow-up data, and thus, the impact on survival outcomes is not established.