Department of General Surgery, Division of Liver Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.
Int J Surg. 2023 Nov 1;109(11):3354-3364. doi: 10.1097/JS9.0000000000000622.
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.
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.
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.
Preoperative dexamethasone administration can help improve perioperative outcomes for HCC patients when applying IPM with a 25-min ischemic interval in hepatectomy.
先前的一项随机对照试验表明，对于肝细胞癌（HCC）患者的肝切除术，可以安全有效地应用 25 分钟缺血间隔的间歇性普雷令氏手法（IPM）。但是延长肝血流阻断时间将不可避免地加重缺血再灌注损伤。因此，我们旨在评估预防性地塞米松对缓解 25 分钟缺血间隔 HCC 患者手术应激的效果。
从 2022 年 12 月至 2023 年 4 月，符合纳入标准的患者被随机分配至地塞米松组或对照组。记录并比较两组患者的围手术期数据和短期生存结局，并进行亚组分析。
270 例患者被分配至地塞米松组（n=135）和对照组（n=135）。地塞米松组患者的连续丙氨酸转氨酶（ALT）曲线下面积（AUC ALT）（P=0.043）和天冬氨酸转氨酶（AST）（P=0.009）、总胆红素（TB）（P=0.018）、降钙素原（PCT）（P=0.012）、白细胞介素-6（IL-6）（P=0.006）、主要并发症发生率（P=0.031）和术后住院时间（P=0.046）均低于对照组。亚组分析显示，地塞米松组对于肝硬化患者的肝细胞损伤较轻，而对于无肝硬化患者，地塞米松组的炎症反应较轻。此外，对于行大肝切除术的患者，地塞米松组的肝功能保存更好，炎症反应较轻，尽管肝细胞损伤无显著改善。
对于应用 25 分钟缺血间隔的 IPM 行肝切除术的 HCC 患者，术前给予地塞米松可有助于改善围手术期结局。
