Perioperative steroid administration reduces overall complications in patients undergoing liver resection: A meta-analysis

Table 1 Patient profile of included studies (distribution, age, sex, and pathology)

Ref.	Number		Age		Sex (M/F)		Pathology
	Steroid	Control	Steroid	Control	Steroid	Control		Steroid	Control
Donadon et al[13], 2016	16	16	65 (27-80)1	63 (22-77)1	10/6	9/7	Metastasis	6	12
							HCC	6	2
							Cholangiocarcinoma	4	0
							Others	0	2
Hasegawa et al[15], 2020	50	50	67 (59-74)2	68 (62–75)2	30/20	31/19	Metastasis	21	14
Hayashi et al[12], 2011	102	98	69 (39-81)1	70 (35-82)1	-	-	Metastasis	32	23
							HCC	63	66
							Cholangiocarcinoma	6	5
							Others	1	4
Muratore et al[20], 2003	25	28	65.4 ± 10.83	64.1 ± 11.73	8/17	11/17	-	-	-
Pulitanò et al[17], 2007	37	36	63 (31-85)4	61.8 (21-78)4	23/14	22/14	Metastasis	16	14
							HCC	12	14
							Cholangiocarcinoma	5	4
							Hemangioendothelioma	1	1
							Benign	3	3
Schmidt et al[18], 2007	10	10	575	655	3/7	4/6	HCC	2	1
							Metastasis	4	4
							Cholangiocarcinoma	0	2
							Benign	4	3
Yamashita et al[16], 2001	17	16	60.3 ± 1.86	56.8 ± 3.96	4/13	11/5	HCC	13	8
							Metastasis	0	3
							Cholangiocarcinoma	0	1
							Living donor of transplant	4	4
Zi et al[19], 2015	40	39	57.55 ± 8.813	57.51 ± 10.323	23/17	17/22	Malignant	31	34
							Benign	9	5

¹Median (range).

²Median (interquartile range).

³mean ± SD.

⁴Mean with range.

⁵Mean.

⁶mean ± SE.

M: Male; F: Female; HCC: Hepatocellular carcinoma.

Table 2 Surgical details of included studies (type of resection, duration, blood loss and volume resected)

Ref.	Type of resection			Duration of operation/min		Volume of blood loss/mL		Volume of liver resected/g
		Steroid	Control	Steroid	Control	Steroid	Control	Steroid	Control
Donadon et al[13], 2016	Minor	9	11	383.5 (235-546)1	351 (226-640)1	275 (100-1000)1	200 (0-700)1	-	-
	Major	7	5
Hasegawa et al[15], 2020	Minor	40	39	215 (170-294)2	233 (157-270)2	52 (29-149)2	34 (17-76)2	-	-
	Major	10	11
Hayashi et al[12], 2011	Hemihepactectomy	11	15	330 (165-834)1	316 (136-697)1	324 (5-1577)1	257 (10-1972)1	77 (4-1930)1	75 (6-1300)1
	Segmentectomy	59	57
	Limited resection	32	26
Muratore et al[20], 2003	Minor	12	13	-	-	322.8 ± 261.43	294.6 ± 271.93	-	-
	Major	13	15
Pulitanò et al[17], 2007	Right hepactectomy	11	10	440 (220-480)1	408 (240-460)1	662 (300-800)1	621 (350-720)1	40.4 ± 203 (%)	39.5 ± 183 (%)
	Left hepatectomy	6	8
	Extended right hepatectomy	5	4
	Extended left hepatectomy	2	2
	Bisegmentectomy	6	4
	Segmentectomy	4	5
	Wedge resection	3	3
Schmidt et al[18], 2007	Segment II/III	4	5	2224	2524	3404	7804	-	-
	Segment V-VIII	6	5
Yamashita et al[16], 2001	Lobectomy or more	5	6	338 ± 215	352 ± 145	892 ± 1065	822 ± 555	239 ± 505	187 ± 335
	Segmentectomy	2	1
	Subsegmentectomy or less	10	9
Zi et al[19], 2015	Major	22	12	342.38 ± 129.733	353.21 ± 168.363	481.25 ± 415.983	496.15 ± 391.593	-	-
	Minor	18	27

¹Median (range).

²Median (interquartile range).

³mean ± SD.

⁴Mean.

⁵mean ± SE.

Table 3 Perioperative steroid protocols of included studies

Ref.	Study design	Country	Steroid protocol	Control protocol
Donadon et al[13], 2016	RCT	Italy	Preoperative bolus infusion (5%) of 500 mg methylprednisolone in 250 mL glucose for 1 h prior to hepatectomy, then continuous infusion for 6 h	250 mL glucose-5% as bolus and subsequent continuous infusion
Hasegawa et al[15], 2020	RCT	Japan	Preoperative, up to 500 mg methylprednisolone in saline solution	Saline only
Hayashi et al[12], 2011	RCT	Japan	Intraoperative 500 mg hydrocortisone immediately prior to hepatic-pedicle clamping 300 mg hydrocortisone on POD1 200 mg on POD 2, 100 mg on POD3	0
Muratore et al[20], 2003	RCT	Italy	Preoperative (30 min before surgery) 30 mg/kg per body weight IV methylprednisolone	0
Pulitanòet al[17], 2007	RCT	Italy	Preoperative 500 mg methylprednisolone	0
Schmidt et al[18], 2007	RCT	Germany	Preoperative (90 min before surgery) 30 mg/kg per body weight IV methylprednisolone	50 mL IV saline
Yamashita et al[16], 2001	RCT	Japan	Preoperative (2 h before surgery) 500 mg IV methylprednisolone	0
Zi et al[19], 2015	RCT	China	Intraoperative 500 mg methylprednisolone prior to liver resection	Hepatectomy only

RCT: Randomized controlled trial; IV: Intravenous; POD: Postoperative day.