Effects of preoperative steroid administration on surgical stress in hepatic resection - Prospective randomised trial

Hypothesis: Preoperative administration of methylprednisolone sodium succinate can control surgical stress in patients undergoing hepatic resection. Design: A prospective randomized trial. Setting: A university hospital department of surgery. Patients: Thirty-three patients who underwent hepatic resection were classified into 2 groups: a control group (n=16) and a steroid group (n=17) in which patients were intravenously administered 500 mg of methylprednisolone 2 hours before surgery. Main Outcome Measures: Perioperative levels of interleukin (IL)-6 and IL-10 (serum and peritoneal), immunosuppressive acidic protein, Candida antigen, and other laboratory and clinical variables were measured. Results: Postoperative levels of serum and peritoneal IL-6 and levels of C-reactive protein were significantly lower in the steroid group than in controls. Furthermore, serum and peritoneal IL-10 levels were significantly higher in the steroid group. The total bilirubin value on postoperative day 1 was significantly lower in the steroid group than in controls. Postoperative immunosuppressive acidic protein levels were also significantly lower in the steroid group, as was the positive rate of serum Candida antigen. No differences were found in the incidence of postoperative complications. Conclusions: Preoperative steroid administration significantly elevated anti-inflammatory cytokine IL-10 levels, suppressed the levels of inflammatory cytokines IL-6 and C-reactive protein, and prevented postoperative elevation of total bilirubin values. Furthermore, postoperative elevation of immunosuppressive acidic protein levels and the positive rate of Candida antigen were suppressed, indicating that the immune response was maintained by preoperative steroid administration.