The efficacy and safety of glucocorticoid for perioperative patients with hepatectomy: a systematic review and meta-analysis

ABSTRACT

Objective

Glucocorticoids have been used in patients undergoing perioperative hepatectomy, however their safety and efficacy remain controversial. This meta-analysis was conducted to investigate this issue and further provide reference for clinical practice.

Methods

PubMed/MEDLINE, Embase, and Cochrane Library were searched for randomized controlled trials (RCTs) from database inception to December 2022. Literature screening and data extraction were performed independently by two reviewers. The methodological quality of the RCTs was assessed using the Jadad scale. RevMan 5.4 was used for the meta-analysis.

Results

A total of 11 RCTs involving 905 patients were included. Compared with the control group, we found perioperative glucocorticoid administration significantly lowered overall complication rate [RR = 0.67; 95% CI (0.55, 0.83); P = 0.0003], infectious complication rate [RR = 0.41; 95% CI (0.21, 0.82); P = 0.01] and postoperative liver failure [RR = 0.63; 95% CI (0.41, 0.97); P = 0.03]. In addition, glucocorticoids appear to improve liver function (TBil) [MD = −0.36, 95% CI (−0.59, −0.14), P = 0.001] and reduce the release of certain inflammatory cytokines (IL-6) [MD = −48.52, 95% CI (−56.88, −40.16), P < 0.00001].

Conclusion

Based on the available evidence, glucocorticoids appear to be safe and effective in patients undergoing hepatectomy, but further research is needed.

KEYWORDS:

• Glucocorticoids
• hepatectomy
• perioperative period
• meta-analysis

Acknowledgments

We thank Professor Kehu Yang from the Evidence-Based Medicine Center of Lanzhou University for guidance.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

G Tiankang and Y Kehu were involved in the conception and design; L Lili, L Tingting, Z Chengren, L Xiong, J Zhiliang, and H Xiangyong were involved in the analysis and interpretation of data; T Hongwei was involved in the analysis and interpretation of data; L Lili and Z Chengren were involved in the drafting of the paper or revising; G Tiankang and Y Kehu were involved in the final approval of the version to be published. All authors agree to be accountable for all aspects of the work.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17474124.2023.2162878

Additional information

Funding

This research was supported by the Natural Science Foundation for Young Scientists and the Science & Technology Planning Project of Gansu Province (20JR10RA403), (18JR3RA058), and (GSWSKY2020-06). The Natural Science Foundation of Gansu Province (21JR7RA649); Lanzhou Science and Technology Foundation (2020-ZD-29).