Aurora Rodríguez1, Pilar Taurà2, Maria I García Domingo3, Eric Herrero3, Judith Camps3, Pilar Forcada4, Sergi Sabaté5, Esteve Cugat3. 1. Department of Anesthesiology, Hospital Universitari Mútua Terrassa, Terrassa, Spain. Electronic address: aurorarc1@gmail.com. 2. Department of Anesthesiology, Liver Surgery and Liver Transplant Unit, Hospital Clinic, Barcelona University, Barcelona, Spain. 3. Department of Surgery, Liver Surgery, Hospital Universitari Mútua Terrassa, Terrassa, Spain. 4. Department of Histopathology, Hospital Universitari Mútua Terrassa, Terrassa, Spain. 5. Department of Anesthesiology, Fundació Puigvert, Barcelona, Spain.
Abstract
BACKGROUND:Ischemic preconditioning (IPC) and anesthetic preconditioning (APC) have been reported to attenuate ischemia-reperfusion (IR) injury after liver resection under continuous inflow occlusion. This study evaluates whether these strategies enhance hepatic protection of remnant liver against IR after liver resection with intermittent clamping (INT). METHODS: A total of 106 patients without underlying liver disease and submitted to liver resection using INT were randomized into 3 groups: IPC (10 minutes of inflow occlusion followed by 10 minutes of reperfusion before liver transection), APC (sevoflurane administration for 20 minutes before liver transection), and INT (no preconditioning). Patients were also stratified according to the extent of the hepatectomy. Cytoprotection was evaluated by comparing hepatocyte and endothelial dysfunction markers, apoptosis, histologic lesions, and postoperative outcome. RESULTS: No differences were observed in preoperative chemotherapy and steatosis, total warm ischemia time, operative time, or blood loss. Kinetics of transaminases (aspartate aminotransferase, P = .137; alanine aminotransferase, P = .616), bilirubin (P = .980), and hyaluronic acid increase (P = .514) revealed no differences. Significant apoptosis was present in 40% of patients, mild-to-moderate leukocyte infiltration and steatosis in 45% and 55%, respectively, and mild sinusoidal congestion in 65%, with a similar distribution in the 3 groups. When patients were stratified by major versus minor resections, no differences were observed in any of the variables studied. Postoperative clinical outcomes were also similar. CONCLUSION: These results suggest that these protocols of IPC and APC used in this study do not provide better cytoprotection from IR when INT is used.
RCT Entities:
BACKGROUND:Ischemic preconditioning (IPC) and anesthetic preconditioning (APC) have been reported to attenuate ischemia-reperfusion (IR) injury after liver resection under continuous inflow occlusion. This study evaluates whether these strategies enhance hepatic protection of remnant liver against IR after liver resection with intermittent clamping (INT). METHODS: A total of 106 patients without underlying liver disease and submitted to liver resection using INT were randomized into 3 groups: IPC (10 minutes of inflow occlusion followed by 10 minutes of reperfusion before liver transection), APC (sevoflurane administration for 20 minutes before liver transection), and INT (no preconditioning). Patients were also stratified according to the extent of the hepatectomy. Cytoprotection was evaluated by comparing hepatocyte and endothelial dysfunction markers, apoptosis, histologic lesions, and postoperative outcome. RESULTS: No differences were observed in preoperative chemotherapy and steatosis, total warm ischemia time, operative time, or blood loss. Kinetics of transaminases (aspartate aminotransferase, P = .137; alanine aminotransferase, P = .616), bilirubin (P = .980), and hyaluronic acid increase (P = .514) revealed no differences. Significant apoptosis was present in 40% of patients, mild-to-moderate leukocyte infiltration and steatosis in 45% and 55%, respectively, and mild sinusoidal congestion in 65%, with a similar distribution in the 3 groups. When patients were stratified by major versus minor resections, no differences were observed in any of the variables studied. Postoperative clinical outcomes were also similar. CONCLUSION: These results suggest that these protocols of IPC and APC used in this study do not provide better cytoprotection from IR when INT is used.
Authors: Theo P Menting; Kimberley E Wever; Denise Md Ozdemir-van Brunschot; Daan Ja Van der Vliet; Maroeska M Rovers; Michiel C Warle Journal: Cochrane Database Syst Rev Date: 2017-03-04