Preoperative steroid administration in liver resection: a systematic review and meta-analysis.

BACKGROUND/AIMS To investigate the outcome of preoperative steroid administration in patients undergoing liver resection using a systematic review and meta-analysis. METHODOLOGY Literature on prospective randomized study of preoperative steroid administration in patients undergoing liver resection published between 1966 and July 2011 was retrieved. A systematic review and meta-analysis were conducted to estimate the surgical stress, clinical benefit and safety. RESULTS The reported surgical stress markers included serum IL-6, IL-10 and CRP. Meta-analysis showed that: 1) steroid group had lower serum IL-6 level on POD 1 and POD 3 (p<0.05), and 2) steroid group had lower serum CRP level on POD 3 (p<0.05) with no significant difference on POD 1 and POD 7. After stratifying by Pringle maneuver and steroid dosage, we found that: 1) intermittent Pringle maneuver might have a better effect in suppressing releasing IL-6; 2) both 30 mg/kg and a single dose of 500 mg benefited patients in suppressing releasing IL-6. The incidences of complications were almost the same between steroid group and control group. CONCLUSIONS Preoperative steroid administration can reduce postoperative surgical stress and has a positive impact on the liver function in patients undergoing liver resection. It does not increase incidence of postoperative complication.