Although prophylactic glucocorticoids have been used before liver resection to minimize liver dysfunction, it is unknown whether treatment with glucocorticoids will accelerates recovery from hyperbilirubinemia after liver resection.
In this open-label, randomized, controlled trial, patients with hyperbilirubinemia (>2.5 × and ≤5 × the upper limit of normal) within 7 days after hepatic resection were assigned randomly to the dexamethasone or control groups. For the dexamethasone group, 10 mg, 10 mg, and 5 mg dexamethasone were administered intravenously on days 0, 1, and 2, respectively, after randomization. For the control group, patients received standard treatment only. The primary outcome was time to recovery from hyperbilirubinemia defined as the period from the day of randomization to the day when serum bilirubin decreased to ≤1.5 times that of the upper limit of normal. Secondary outcomes were the prevalence of postoperative complications, postoperative hospital stay, and hospital expense.
Between March 2016 and December 2017, 76 participants were enrolled (38 in each group). Median time to recovery from hyperbilirubinemia was less in the dexamethasone group than in the control group (2 vs 4 days, P < .001). Serum bilirubin levels were less in the dexamethasone group on days 1–3 after randomization (P < .05). The prevalence of infection, posthepatectomy liver failure, postoperative hospital stay, and hospital expense were not different between the groups.
Dexamethasone accelerated recovery from hyperbilirubinemia and decreased serum bilirubin levels without causing more side effects in patients after hepatectomy.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Hepatic resection associated with good survival for selected patients with intermediate and advanced-stage hepatocellular carcinoma.Ann Surg. 2014; 260: 329-340
- Partial hepatectomy vs. transcatheter arterial chemoembolization for resectable multiple hepatocellular carcinoma beyond Milan Criteria: a RCT.J Hepatol. 2014; 61: 82-88
- Surgical treatment of giant liver hemangioma larger than 10 cm: a single center's experience with 86 patients.Medicine (Baltimore). 2015; 94: e1420
- A snapshot of the effective indications and results of surgery for hepatocellular carcinoma in tertiary referral centers: is it adherent to the EASL/AASLD recommendations?: an observational study of the HCC East-West study group.Ann Surg. 2013; 257: 929-937
- Validation of the Conventional Resection Criteria in patients with hepatocellular carcinoma in terms of the incidence of posthepatectomy liver failure and long-term prognosis.Dig Surg. 2015; 32: 344-351
- Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS).Surgery. 2011; 149: 713-724
- Relevance of the ISGLS definition of posthepatectomy liver failure in early prediction of poor outcome after liver resection: study on 680 hepatectomies.Ann Surg. 2014; 260 (discussion 70): 865-870
- Prospective evaluation of the International Study Group for Liver Surgery definition of post hepatectomy liver failure after liver resection: an international multicentre study.HPB (Oxford). 2018; 20: 462-469
- Hypophosphatemia and recovery of post-hepatectomy liver insufficiency.Hepatobiliary Surg Nutr. 2016; 5: 217-224
- The "50-50 criteria" on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy.Ann Surg. 2005; 242 (discussion 8–9): 824-828
- Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy.J Am Coll Surg. 2007; 204 (discussion 62–4): 854-862
- Predictive power of prothrombin time and serum total bilirubin for postoperative mortality after major hepatectomy with extrahepatic bile duct resection.Surgery. 2014; 155: 504-511
- Prospective validation of the "fifty-fifty" criteria as an early and accurate predictor of death after liver resection in intensive care unit patients.Ann Surg. 2009; 249: 124-128
- Acute-on-chronic liver failure: terminology, mechanisms and management.Nat Rev Gastroenterol Hepatol. 2016; 13: 131-149
- Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data.Gut. 2011; 60: 255-260
- Prednisolone or pentoxifylline for alcoholic hepatitis.N Engl J Med. 2015; 372: 1619-1628
- Beneficial effect of corticosteroids for patients with severe drug-induced liver injury.J Dig Dis. 2016; 17: 618-627
- Glucocorticoids can increase the survival rate of patients with severe viral hepatitis B: a meta-analysis.Eur J Gastroenterol Hepatol. 2013; 25: 926-934
- Dexamethasone in outcome of patients with hepatitis B virus-related acute-on-chronic liver failure.J Gastroenterol Hepatol. 2014; 29: 800-806
- Impact of preoperative steroids administration on ischemia-reperfusion injury and systemic responses in liver surgery: a prospective randomized study.Liver Transpl. 2006; 12: 941-949
- Validation of perioperative steroids administration in liver resection: a randomized controlled trial.Ann Surg. 2011; 253: 50-55
- Preoperative high-dose steroid administration attenuates the surgical stress response following liver resection: results of a prospective randomized study.J Hepatobiliary Pancreat Surg. 2007; 14: 484-492
- Effects of preoperative steroid administration on surgical stress in hepatic resection: prospective randomized trial.Arch Surg. 2001; 136: 328-333
- Liver stiffness assessed by shear wave elastography predicts postoperative liver failure in patients with hepatocellular carcinoma.J Gastrointest Surg. 2017; 21: 1471-1479
- Preoperative glucocorticoid use in major abdominal surgery: systematic review and meta-analysis of randomized trials.Ann Surg. 2011; 254: 183-191
- Use of pre-operative steroids in liver resection: a systematic review and meta-analysis.HPB (Oxford). 2014; 16: 12-19
- Systematic review and meta-analysis of the effect of perioperative steroids on ischaemia-reperfusion injury and surgical stress response in patients undergoing liver resection.Br J Surg. 2013; 100: 600-609
- Effects of biliary obstruction on hepatic deoxyribonucleic acid and protein synthesis after partial hepatectomy.Hepatogastroenterology. 1997; 44: 501-507
- Clinicohistological features of liver failure after excessive hepatectomy.Hepatogastroenterology. 2002; 49: 354-358
- Hyperstimulation with interleukin 6 inhibits cell cycle progression after hepatectomy in mice.Hepatology. 2000; 32: 514-522
- Prospective randomized study of steroids in the prevention of ischaemic injury during hepatic resection with pedicle clamping.Br J Surg. 2003; 90: 17-22
- Prevention and management of glucocorticoid-induced side effects: a comprehensive review: gastrointestinal and endocrinologic side effects.J Am Acad Dermatol. 2017; 76: 11-16
- Management of post-hepatectomy complications.World J Gastroenterol. 2013; 19: 7983-7991
- A randomized placebo-controlled trial of prophylactic dexamethasone for transcatheter arterial chemoembolization.Hepatology. 2017;
Published online: October 19, 2018
Accepted: September 13, 2018
Received in revised form: September 7, 2018
Received: July 15, 2018
© 2018 Elsevier Inc. All rights reserved.