Risks and benefits of application of preoperative glucocorticoid in major abdominal surgery: a systematic review_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Jingshu ¹ , DU Shuxiang ² , LIANG Yanxu ¹ , ZHANG Lulu ² , WANG Tao ² , WU Gang ³ ,  SUN Peichun ³

1. Department of Gastrointestinal Surgery, People’s Hospital of Henan University, Kaifeng, Henan 475000, P. R. China;
2. Department of Gastrointestinal Surgery, People’s Hospital of Zhengzhou University, Zhengzhou 450003, P. R. China;
3. Department of Gastrointestinal Surgery, Henan Provincial People’s Hospital, Zhengzhou 450003, P. R. China;

Corresponding author：

SUN Peichun, Email: sunpeichun@163.com

Keywords：

preoperative application of glucocorticoid; abdominal surgery; meta-analysis

DOI：

10.7507/1007-9424.202212033

Video：

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Objective To evaluate the clinical short-term efficacy and safety of application of glucocorticoids (GCs) before major abdominal surgery. Methods The randomized controlled trials (RCTs) on application of GCs before major elective abdominal surgery were systematically and comprehensively searched in Medline (1966–2022), Embase (1947–2022), Web of Science, and PubMed databases, and systematic review and meta-analysis of the included studies were performed to explore the effects of application of GCs before major abdominal surgery on postoperative complication, hospital stay, and serum interleukin-6 level. Results Nineteen moderate quality RCTs with 1 535 patients were finally included in the analysis. Preoperative application of GCs reduced postoperative IL-6 level [MD=–51.00, 95%CI (–62.36, –39.63), P<0.001], reduced postoperative complications [OR=0.53, 95%CI (0.35, 0.81), P=0.003], shorten hospital stay [MD=–0.64, 95%CI (–1.04, –0.24), P=0.002], and reduced the occurrence of infectious complications [OR=0.50, 95%CI (0.36, 0.70), P<0.01]. However, there were no statistically significant difference in incidence of anastomotic leakage [OR=1.15, 95%CI (0.43, 3.04), P=0.780] and bile leakage [OR=1.95, 95%CI (0.76, 5.00), P=0.170]. Conclusion Preoperative application of GCs can reduce the level of IL-6, reduce complications after major abdominal surgery and shorten postoperative hospital stay.

Citation： YANG Jingshu, DU Shuxiang, LIANG Yanxu, ZHANG Lulu, WANG Tao, WU Gang, SUN Peichun. Risks and benefits of application of preoperative glucocorticoid in major abdominal surgery: a systematic review. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(5): 595-602. doi: 10.7507/1007-9424.202212033 Copy

1.	Wilmore DW. Metabolic response to severe surgical illness: overview. World J Surg, 2000, 24(6): 705-711.
2.	Desborough JP. The stress response to trauma and surgery. Br J Anaesth, 2000, 85(1): 109-117.
3.	Beilin B, Bessler H, Mayburd E, et al. Effects of preemptive analgesia on pain and cytokine production in the postoperative period. Anesthesiology, 2003, 98(1): 151-155.
4.	Mokart D, Merlin M, Sannini A, et al. Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery. Br J Anaesth, 2005, 94(6): 767-773.
5.	Holte K, Kehlet H. Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. J Am Coll Surg, 2002, 195(5): 694-712.
6.	Barber AE, Coyle SM, Fischer E, et al. Influence of hypercortisolemia on soluble tumor necrosis factor receptorⅡ and interleukin-1 receptor antagonist responses to endotoxin in human beings. Surgery, 1995, 118(2): 406-410.
7.	中华医学会外科学分会, 中华医学会麻醉学分会. 中国加速康复外科临床实践指南(2021版). 中国实用外科杂志, 2021, 41(9): 961-992.
8.	Thorell A, Nygren J, Ljungqvist O. Insulin resistance: a marker of surgical stress. Curr Opin Clin Nutr Metab Care, 1999, 2(1): 69-78.
9.	McSorley ST, Horgan PG, McMillan DC. The impact of preoperative corticosteroids on the systemic inflammatory response and postoperative complications following surgery for gastrointestinal cancer: a systematic review and meta-analysis. Crit Rev Oncol Hematol, 2016, 101: 139-150.
10.	Srinivasa S, Kahokehr AA, Yu TC, et al. Preoperative glucocorticoid use in major abdominal surgery: systematic review and meta-analysis of randomized trials. Ann Surg, 2011, 254(2): 183-191.
11.	Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev, 2015, 4(1): 1. doi: 10.1186/2046-4053-4-1.
12.	Badia JM, Whawell SA, Scott-Coombes DM, et al. Peritoneal and systemic cytokine response to laparotomy. Br J Surg, 1996, 83(3): 347-348.
13.	Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol, 2005, 5: 13. doi: 10.1186/1471-2288-5-13.
14.	Pulitanò C, Aldrighetti L, Arru M, et al. Prospective randomized study of the benefits of preoperative corticosteroid administration on hepatic ischemia-reperfusion injury and cytokine response in patients undergoing hepatic resection. HPB (Oxford), 2007, 9(3): 183-189.
15.	Yamashita Y, Shimada M, Hamatsu T, et al. Effects of preoperative steroid administration on surgical stress in hepatic resection: prospective randomized trial. Arch Surg, 2001, 136(3): 328-333.
16.	Xiang XB, Chen H, Wu YL, et al. The Effect of preoperative methylprednisolone on postoperative delirium in older patients undergoing gastrointestinal surgery: a randomized, double-blind, placebo-controlled trial. J Gerontol A Biol Sci Med Sci, 2022, 77(3): 517-523.
17.	Aldrighetti L, Pulitanò C, Arru M, et al. Impact of preoperative steroids administration on ischemia-reperfusion injury and systemic responses in liver surgery: a prospective randomized study. Liver Transpl, 2006, 12(6): 941-949.
18.	Schmidt SC, Hamann S, Langrehr JM, et al. Preoperative high-dose steroid administration attenuates the surgical stress response following liver resection: results of a prospective randomized study. J Hepatobiliary Pancreat Surg, 2007, 14(5): 484-492.
19.	Kirdak T, Yilmazlar A, Cavun S, et al. Does single, low-dose preoperative dexamethasone improve outcomes after colorectal surgery based on an enhanced recovery protocol? Double-blind, randomized clinical trial. Am Surg, 2008, 74(2): 160-167.
20.	Vignali A, Di Palo S, Orsenigo E, et al. Effect of prednisolone on local and systemic response in laparoscopic vs. open colon surgery: a randomized, double-blind, placebo-controlled trial. Dis Colon Rectum, 2009, 52(6): 1080-1088.
21.	Zargar-Shoshtari K, Sammour T, Kahokehr A, et al. Randomized clinical trial of the effect of glucocorticoids on peritoneal inflammation and postoperative recovery after colectomy. Br J Surg, 2009, 96(11): 1253-1261.
22.	Jensen KK, Brøndum TL, Leerhøy B, et al. Preoperative, single, high-dose glucocorticoid administration in abdominal wall reconstruction: a randomized, double-blinded clinical trial. Surgery, 2020, 167(4): 757-764.
23.	Steinthorsdottir KJ, Awada HN, Schultz NA, et al. Preoperative high-dose glucocorticoids for early recovery after liver resection: randomized double-blinded trial. BJS Open, 2021, 5(5): zrab063. doi: 10.1093/bjsopen/zrab063.
24.	Zhang T, Xu Y, Yao Y, et al. Randomized controlled trial: perioperative dexamethasone reduces excessive postoperative inflammatory response and ileus after surgery for inflammatory bowel disease. Inflamm Bowel Dis, 2021, 27(11): 1756-1765.
25.	Bressan AK, Isherwood S, Bathe OF, et al. Preoperative single-dose methylprednisolone prevents surgical site infections after major liver resection: a randomized controlled trial. Ann Surg, 2022, 275(2): 281-287.
26.	Schulze S, Andersen J, Overgaard H, et al. Effect of prednisolone on the systemic response and wound healing after colonic surgery. Arch Surg, 1997, 132(2): 129-135.
27.	Chen Y, Dong C, Lian G, et al. Dexamethasone on postoperative gastrointestinal motility: a placebo-controlled, double-blinded, randomized controlled trial. J Gastroenterol Hepatol, 2020, 35(9): 1549-1554.
28.	Hasegawa Y, Nitta H, Takahara T, et al. Glucocorticoid use and ischemia-reperfusion injury in laparoscopic liver resection: randomized controlled trial. Ann Gastroenterol Surg, 2019, 4(1): 76-83.
29.	Pulitanò C, Aldrighetti L, Finazzi R, et al. Inihibition of cytokine response by methylprednisolone attenuates antithrombin reduction following hepatic resection. Thromb Haemost, 2005, 93(6): 1199-1200.
30.	Turner S, Dhamarajah S, Bosomworth M, et al. Effect of perioperative steroids on renal function after liver transplantation. Anaesthesia, 2006, 61(3): 253-259.
31.	Muratore A, Ribero D, Ferrero A, et al. Prospective randomized study of steroids in the prevention of ischaemic injury during hepatic resection with pedicle clamping. Br J Surg, 2003, 90(1): 17-22.
32.	Nagelschmidt M, Fu ZX, Saad S, et al. Preoperative high dose methylprednisolone improves patients outcome after abdominal surgery. Eur J Surg, 1999, 165(10): 971-978.
33.	Desborough JP. The stress response to trauma and surgery. Br J Anaesth, 2000, 85(1): 109-117.
34.	Herroeder S, Pecher S, Schönherr ME, et al. Systemic lidocaine shortens length of hospital stay after colorectal surgery: a double-blinded, randomized, placebo-controlled trial. Ann Surg, 2007, 246(2): 192-200.
35.	Choi YJ, Han H, Lee JH, et al. Particulate matter10-induced airway inflammation and fibrosis can be regulated by chitinase-1 suppression. Respir Res, 2023, 24(1): 85. doi: 10.1186/s12931-023-02392-8.
36.	DREAMS Trial Collaborators and West Midlands Research Collaborative. Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial). BMJ, 2017, 357: j1455. doi: 10.1136/bmj.j1455.
37.	Hirano Y, Konishi T, Kaneko H, et al. Impact of prophylactic corticosteroid use on in-hospital mortality and respiratory failure after esophagectomy for esophageal cancer: nationwide inpatient data study in Japan. Ann Surg, 2022 Jul 14. doi: 10.1097/SLA.0000000000005502. Online ahead of print.
38.	Glanemann M, Münchow S, Schirmeier A, et al. Steroid administration before partial hepatectomy with temporary inflow occlusion does not influence cyclin D1 and Ki-67 related liver regeneration. Langenbecks Arch Surg, 2004, 389(5): 380-386.
39.	Wüstefeld T, Rakemann T, Kubicka S, et al. Hyperstimulation with interleukin 6 inhibits cell cycle progression after hepatectomy in mice. Hepatology, 2000, 32(3): 514-522.
40.	Lei Y, Huang Z, Huang Q, et al. Dose optimization of intravenous dexamethasone for total knee arthroplasty: when two is not better than one. Arch Orthop Trauma Surg, 2022, 142(4): 665-672.
41.	Li X, Song B, Teng X, et al. Low dose of methylprednisolone for pain and immune function after thoracic surgery. Ann Thorac Surg, 2022, 113(4): 1325-1332.
42.	Kodama M, Kodama T. Enhancing effect of hydrocortisone on hematogenous metastasis of Ehrlich ascites tumor in mice. Cancer Res, 1975, 35(4): 1015-1021.
43.	van der Bij GJ, Oosterling SJ, Beelen RH, et al. The perioperative period is an underutilized window of therapeutic opportunity in patients with colorectal cancer. Ann Surg, 2009, 249(5): 727-734.
44.	Taniguchi Y, Kurokawa Y, Hagi T, et al. Methylprednisolone inhibits tumor growth and peritoneal seeding induced by surgical stress and postoperative complications. Ann Surg Oncol, 2019, 26(9): 2831-2838.

1. Wilmore DW. Metabolic response to severe surgical illness: overview. World J Surg, 2000, 24(6): 705-711.
2. Desborough JP. The stress response to trauma and surgery. Br J Anaesth, 2000, 85(1): 109-117.
3. Beilin B, Bessler H, Mayburd E, et al. Effects of preemptive analgesia on pain and cytokine production in the postoperative period. Anesthesiology, 2003, 98(1): 151-155.
4. Mokart D, Merlin M, Sannini A, et al. Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery. Br J Anaesth, 2005, 94(6): 767-773.
5. Holte K, Kehlet H. Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. J Am Coll Surg, 2002, 195(5): 694-712.
6. Barber AE, Coyle SM, Fischer E, et al. Influence of hypercortisolemia on soluble tumor necrosis factor receptorⅡ and interleukin-1 receptor antagonist responses to endotoxin in human beings. Surgery, 1995, 118(2): 406-410.
7. 中华医学会外科学分会, 中华医学会麻醉学分会. 中国加速康复外科临床实践指南(2021版). 中国实用外科杂志, 2021, 41(9): 961-992.
8. Thorell A, Nygren J, Ljungqvist O. Insulin resistance: a marker of surgical stress. Curr Opin Clin Nutr Metab Care, 1999, 2(1): 69-78.
9. McSorley ST, Horgan PG, McMillan DC. The impact of preoperative corticosteroids on the systemic inflammatory response and postoperative complications following surgery for gastrointestinal cancer: a systematic review and meta-analysis. Crit Rev Oncol Hematol, 2016, 101: 139-150.
10. Srinivasa S, Kahokehr AA, Yu TC, et al. Preoperative glucocorticoid use in major abdominal surgery: systematic review and meta-analysis of randomized trials. Ann Surg, 2011, 254(2): 183-191.
11. Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev, 2015, 4(1): 1. doi: 10.1186/2046-4053-4-1.
12. Badia JM, Whawell SA, Scott-Coombes DM, et al. Peritoneal and systemic cytokine response to laparotomy. Br J Surg, 1996, 83(3): 347-348.
13. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol, 2005, 5: 13. doi: 10.1186/1471-2288-5-13.
14. Pulitanò C, Aldrighetti L, Arru M, et al. Prospective randomized study of the benefits of preoperative corticosteroid administration on hepatic ischemia-reperfusion injury and cytokine response in patients undergoing hepatic resection. HPB (Oxford), 2007, 9(3): 183-189.
15. Yamashita Y, Shimada M, Hamatsu T, et al. Effects of preoperative steroid administration on surgical stress in hepatic resection: prospective randomized trial. Arch Surg, 2001, 136(3): 328-333.
16. Xiang XB, Chen H, Wu YL, et al. The Effect of preoperative methylprednisolone on postoperative delirium in older patients undergoing gastrointestinal surgery: a randomized, double-blind, placebo-controlled trial. J Gerontol A Biol Sci Med Sci, 2022, 77(3): 517-523.
17. Aldrighetti L, Pulitanò C, Arru M, et al. Impact of preoperative steroids administration on ischemia-reperfusion injury and systemic responses in liver surgery: a prospective randomized study. Liver Transpl, 2006, 12(6): 941-949.
18. Schmidt SC, Hamann S, Langrehr JM, et al. Preoperative high-dose steroid administration attenuates the surgical stress response following liver resection: results of a prospective randomized study. J Hepatobiliary Pancreat Surg, 2007, 14(5): 484-492.
19. Kirdak T, Yilmazlar A, Cavun S, et al. Does single, low-dose preoperative dexamethasone improve outcomes after colorectal surgery based on an enhanced recovery protocol? Double-blind, randomized clinical trial. Am Surg, 2008, 74(2): 160-167.
20. Vignali A, Di Palo S, Orsenigo E, et al. Effect of prednisolone on local and systemic response in laparoscopic vs. open colon surgery: a randomized, double-blind, placebo-controlled trial. Dis Colon Rectum, 2009, 52(6): 1080-1088.
21. Zargar-Shoshtari K, Sammour T, Kahokehr A, et al. Randomized clinical trial of the effect of glucocorticoids on peritoneal inflammation and postoperative recovery after colectomy. Br J Surg, 2009, 96(11): 1253-1261.
22. Jensen KK, Brøndum TL, Leerhøy B, et al. Preoperative, single, high-dose glucocorticoid administration in abdominal wall reconstruction: a randomized, double-blinded clinical trial. Surgery, 2020, 167(4): 757-764.
23. Steinthorsdottir KJ, Awada HN, Schultz NA, et al. Preoperative high-dose glucocorticoids for early recovery after liver resection: randomized double-blinded trial. BJS Open, 2021, 5(5): zrab063. doi: 10.1093/bjsopen/zrab063.
24. Zhang T, Xu Y, Yao Y, et al. Randomized controlled trial: perioperative dexamethasone reduces excessive postoperative inflammatory response and ileus after surgery for inflammatory bowel disease. Inflamm Bowel Dis, 2021, 27(11): 1756-1765.
25. Bressan AK, Isherwood S, Bathe OF, et al. Preoperative single-dose methylprednisolone prevents surgical site infections after major liver resection: a randomized controlled trial. Ann Surg, 2022, 275(2): 281-287.
26. Schulze S, Andersen J, Overgaard H, et al. Effect of prednisolone on the systemic response and wound healing after colonic surgery. Arch Surg, 1997, 132(2): 129-135.
27. Chen Y, Dong C, Lian G, et al. Dexamethasone on postoperative gastrointestinal motility: a placebo-controlled, double-blinded, randomized controlled trial. J Gastroenterol Hepatol, 2020, 35(9): 1549-1554.
28. Hasegawa Y, Nitta H, Takahara T, et al. Glucocorticoid use and ischemia-reperfusion injury in laparoscopic liver resection: randomized controlled trial. Ann Gastroenterol Surg, 2019, 4(1): 76-83.
29. Pulitanò C, Aldrighetti L, Finazzi R, et al. Inihibition of cytokine response by methylprednisolone attenuates antithrombin reduction following hepatic resection. Thromb Haemost, 2005, 93(6): 1199-1200.
30. Turner S, Dhamarajah S, Bosomworth M, et al. Effect of perioperative steroids on renal function after liver transplantation. Anaesthesia, 2006, 61(3): 253-259.
31. Muratore A, Ribero D, Ferrero A, et al. Prospective randomized study of steroids in the prevention of ischaemic injury during hepatic resection with pedicle clamping. Br J Surg, 2003, 90(1): 17-22.
32. Nagelschmidt M, Fu ZX, Saad S, et al. Preoperative high dose methylprednisolone improves patients outcome after abdominal surgery. Eur J Surg, 1999, 165(10): 971-978.
33. Desborough JP. The stress response to trauma and surgery. Br J Anaesth, 2000, 85(1): 109-117.
34. Herroeder S, Pecher S, Schönherr ME, et al. Systemic lidocaine shortens length of hospital stay after colorectal surgery: a double-blinded, randomized, placebo-controlled trial. Ann Surg, 2007, 246(2): 192-200.
35. Choi YJ, Han H, Lee JH, et al. Particulate matter10-induced airway inflammation and fibrosis can be regulated by chitinase-1 suppression. Respir Res, 2023, 24(1): 85. doi: 10.1186/s12931-023-02392-8.
36. DREAMS Trial Collaborators and West Midlands Research Collaborative. Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial). BMJ, 2017, 357: j1455. doi: 10.1136/bmj.j1455.
37. Hirano Y, Konishi T, Kaneko H, et al. Impact of prophylactic corticosteroid use on in-hospital mortality and respiratory failure after esophagectomy for esophageal cancer: nationwide inpatient data study in Japan. Ann Surg, 2022 Jul 14. doi: 10.1097/SLA.0000000000005502. Online ahead of print.
38. Glanemann M, Münchow S, Schirmeier A, et al. Steroid administration before partial hepatectomy with temporary inflow occlusion does not influence cyclin D1 and Ki-67 related liver regeneration. Langenbecks Arch Surg, 2004, 389(5): 380-386.
39. Wüstefeld T, Rakemann T, Kubicka S, et al. Hyperstimulation with interleukin 6 inhibits cell cycle progression after hepatectomy in mice. Hepatology, 2000, 32(3): 514-522.
40. Lei Y, Huang Z, Huang Q, et al. Dose optimization of intravenous dexamethasone for total knee arthroplasty: when two is not better than one. Arch Orthop Trauma Surg, 2022, 142(4): 665-672.
41. Li X, Song B, Teng X, et al. Low dose of methylprednisolone for pain and immune function after thoracic surgery. Ann Thorac Surg, 2022, 113(4): 1325-1332.
42. Kodama M, Kodama T. Enhancing effect of hydrocortisone on hematogenous metastasis of Ehrlich ascites tumor in mice. Cancer Res, 1975, 35(4): 1015-1021.
43. van der Bij GJ, Oosterling SJ, Beelen RH, et al. The perioperative period is an underutilized window of therapeutic opportunity in patients with colorectal cancer. Ann Surg, 2009, 249(5): 727-734.
44. Taniguchi Y, Kurokawa Y, Hagi T, et al. Methylprednisolone inhibits tumor growth and peritoneal seeding induced by surgical stress and postoperative complications. Ann Surg Oncol, 2019, 26(9): 2831-2838.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Risks and benefits of application of preoperative glucocorticoid in major abdominal surgery: a systematic review

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