Matteo Donadon1, Andrea Forastieri Molinari2, Francesco Corazzi2, Laura Rocchi2, Paola Zito2, Matteo Cimino1, Guido Costa1, Ferdinando Raimondi2, Guido Torzilli3. 1. Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital, Via Manzoni, 56, 20089, Rozzano, Milan, Italy. 2. Department of Anesthesiology and Intensive Care, Humanitas University, Humanitas Research Hospital, Via Manzoni, 56, 20089, Rozzano, Milan, Italy. 3. Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital, Via Manzoni, 56, 20089, Rozzano, Milan, Italy. guido.torzilli@humanitas.it.
Abstract
BACKGROUND: The Pringle maneuver, which is performed during liver surgery to reduce blood loss, may result in liver ischemia/reperfusion injury resulting in metabolic, immunological, and microvascular changes, which may lead to hepatocellular damage. The aim of this study was the investigation of the effects of N-acetylcysteine (NAC) and methylprednisolone (MET) in the modulation of liver warm ischemia during hepatic resection. METHODS:Forty-eight patients were enrolled in a pilot double-blind, randomized clinical trial. The patients received either NAC, MET, or placebo. The primary endpoint was the reduction in postoperative alanine aminotransferase and bilirubin. The secondary endpoint was the difference in morbidity and mortality. RESULTS: All the 48 patients had liver resection with no mortality. Morbidity was observed in 8 (16 %) patients equally distributed among the groups. There was a significant favorable recovery of liver function tests in patients treated with NAC or MET compared with the placebo when the Pringle maneuver exceeded 70 min. CONCLUSIONS: The administration of NAC or MET prior to the Pringle maneuver during hepatic resection is associated with lower postoperative aberration in liver function tests compared with placebo when the Pringle maneuver exceeded 70 min. Larger studies are required to validate our findings and to investigate the specific role of NAC and MET in liver surgery.
RCT Entities:
BACKGROUND: The Pringle maneuver, which is performed during liver surgery to reduce blood loss, may result in liver ischemia/reperfusion injury resulting in metabolic, immunological, and microvascular changes, which may lead to hepatocellular damage. The aim of this study was the investigation of the effects of N-acetylcysteine (NAC) and methylprednisolone (MET) in the modulation of liver warm ischemia during hepatic resection. METHODS: Forty-eight patients were enrolled in a pilot double-blind, randomized clinical trial. The patients received either NAC, MET, or placebo. The primary endpoint was the reduction in postoperative alanine aminotransferase and bilirubin. The secondary endpoint was the difference in morbidity and mortality. RESULTS: All the 48 patients had liver resection with no mortality. Morbidity was observed in 8 (16 %) patients equally distributed among the groups. There was a significant favorable recovery of liver function tests in patients treated with NAC or MET compared with the placebo when the Pringle maneuver exceeded 70 min. CONCLUSIONS: The administration of NAC or MET prior to the Pringle maneuver during hepatic resection is associated with lower postoperative aberration in liver function tests compared with placebo when the Pringle maneuver exceeded 70 min. Larger studies are required to validate our findings and to investigate the specific role of NAC and MET in liver surgery.
Authors: Jong Man Kim; Shin Hwang; Kwang-Woong Lee; Jae-Geun Lee; Je Ho Ryu; Bong-Wan Kim; Dong Lak Choi; Young Kyoung You; Dong-Sik Kim; Yang Won Nah; Koo Jeong Kang; Jai Young Cho; Geun Hong; In Seok Choi; Hee Chul Yu; Dongho Choi; Myoung Soo Kim Journal: Hepatobiliary Surg Nutr Date: 2020-08 Impact factor: 7.293