Pharmacological Modulation of Ischemic-Reperfusion Injury during Pringle Maneuver in Hepatic Surgery. A Prospective Randomized Pilot Study

Matteo Donadon, Andrea Forastieri Molinari, Francesco Corazzi, Laura Rocchi, Paola Zito, Matteo Cimino, Guido Costa, Ferdinando Raimondi, Guido Torzilli

Research output: Contribution to journalArticle

Abstract

Background: The Pringle maneuver, which is performed during liver surgery to reduce blood loss, may result in liver ischemia/reperfusion injury resulting in metabolic, immunological, and microvascular changes, which may lead to hepatocellular damage. The aim of this study was the investigation of the effects of N-acetylcysteine (NAC) and methylprednisolone (MET) in the modulation of liver warm ischemia during hepatic resection. Methods: Forty-eight patients were enrolled in a pilot double-blind, randomized clinical trial. The patients received either NAC, MET, or placebo. The primary endpoint was the reduction in postoperative alanine aminotransferase and bilirubin. The secondary endpoint was the difference in morbidity and mortality. Results: All the 48 patients had liver resection with no mortality. Morbidity was observed in 8 (16 %) patients equally distributed among the groups. There was a significant favorable recovery of liver function tests in patients treated with NAC or MET compared with the placebo when the Pringle maneuver exceeded 70 min. Conclusions: The administration of NAC or MET prior to the Pringle maneuver during hepatic resection is associated with lower postoperative aberration in liver function tests compared with placebo when the Pringle maneuver exceeded 70 min. Larger studies are required to validate our findings and to investigate the specific role of NAC and MET in liver surgery.

Original languageEnglish
Pages (from-to)1-11
Number of pages11
JournalWorld Journal of Surgery
DOIs
Publication statusAccepted/In press - Apr 19 2016

Fingerprint

Reperfusion Injury
Methylprednisolone
Acetylcysteine
Pharmacology
Liver
Liver Function Tests
Placebos
Morbidity
Warm Ischemia
Mortality
Recovery of Function
Alanine Transaminase
Bilirubin
Randomized Controlled Trials

ASJC Scopus subject areas

  • Surgery

Cite this

Pharmacological Modulation of Ischemic-Reperfusion Injury during Pringle Maneuver in Hepatic Surgery. A Prospective Randomized Pilot Study. / Donadon, Matteo; Molinari, Andrea Forastieri; Corazzi, Francesco; Rocchi, Laura; Zito, Paola; Cimino, Matteo; Costa, Guido; Raimondi, Ferdinando; Torzilli, Guido.

In: World Journal of Surgery, 19.04.2016, p. 1-11.

Research output: Contribution to journalArticle

Donadon, Matteo ; Molinari, Andrea Forastieri ; Corazzi, Francesco ; Rocchi, Laura ; Zito, Paola ; Cimino, Matteo ; Costa, Guido ; Raimondi, Ferdinando ; Torzilli, Guido. / Pharmacological Modulation of Ischemic-Reperfusion Injury during Pringle Maneuver in Hepatic Surgery. A Prospective Randomized Pilot Study. In: World Journal of Surgery. 2016 ; pp. 1-11.
@article{1bf8af064d6043b5bf6fcad0563135e2,
title = "Pharmacological Modulation of Ischemic-Reperfusion Injury during Pringle Maneuver in Hepatic Surgery. A Prospective Randomized Pilot Study",
abstract = "Background: The Pringle maneuver, which is performed during liver surgery to reduce blood loss, may result in liver ischemia/reperfusion injury resulting in metabolic, immunological, and microvascular changes, which may lead to hepatocellular damage. The aim of this study was the investigation of the effects of N-acetylcysteine (NAC) and methylprednisolone (MET) in the modulation of liver warm ischemia during hepatic resection. Methods: Forty-eight patients were enrolled in a pilot double-blind, randomized clinical trial. The patients received either NAC, MET, or placebo. The primary endpoint was the reduction in postoperative alanine aminotransferase and bilirubin. The secondary endpoint was the difference in morbidity and mortality. Results: All the 48 patients had liver resection with no mortality. Morbidity was observed in 8 (16 {\%}) patients equally distributed among the groups. There was a significant favorable recovery of liver function tests in patients treated with NAC or MET compared with the placebo when the Pringle maneuver exceeded 70 min. Conclusions: The administration of NAC or MET prior to the Pringle maneuver during hepatic resection is associated with lower postoperative aberration in liver function tests compared with placebo when the Pringle maneuver exceeded 70 min. Larger studies are required to validate our findings and to investigate the specific role of NAC and MET in liver surgery.",
author = "Matteo Donadon and Molinari, {Andrea Forastieri} and Francesco Corazzi and Laura Rocchi and Paola Zito and Matteo Cimino and Guido Costa and Ferdinando Raimondi and Guido Torzilli",
year = "2016",
month = "4",
day = "19",
doi = "10.1007/s00268-016-3506-1",
language = "English",
pages = "1--11",
journal = "World Journal of Surgery",
issn = "0364-2313",
publisher = "Springer New York",

}

TY - JOUR

T1 - Pharmacological Modulation of Ischemic-Reperfusion Injury during Pringle Maneuver in Hepatic Surgery. A Prospective Randomized Pilot Study

AU - Donadon, Matteo

AU - Molinari, Andrea Forastieri

AU - Corazzi, Francesco

AU - Rocchi, Laura

AU - Zito, Paola

AU - Cimino, Matteo

AU - Costa, Guido

AU - Raimondi, Ferdinando

AU - Torzilli, Guido

PY - 2016/4/19

Y1 - 2016/4/19

N2 - Background: The Pringle maneuver, which is performed during liver surgery to reduce blood loss, may result in liver ischemia/reperfusion injury resulting in metabolic, immunological, and microvascular changes, which may lead to hepatocellular damage. The aim of this study was the investigation of the effects of N-acetylcysteine (NAC) and methylprednisolone (MET) in the modulation of liver warm ischemia during hepatic resection. Methods: Forty-eight patients were enrolled in a pilot double-blind, randomized clinical trial. The patients received either NAC, MET, or placebo. The primary endpoint was the reduction in postoperative alanine aminotransferase and bilirubin. The secondary endpoint was the difference in morbidity and mortality. Results: All the 48 patients had liver resection with no mortality. Morbidity was observed in 8 (16 %) patients equally distributed among the groups. There was a significant favorable recovery of liver function tests in patients treated with NAC or MET compared with the placebo when the Pringle maneuver exceeded 70 min. Conclusions: The administration of NAC or MET prior to the Pringle maneuver during hepatic resection is associated with lower postoperative aberration in liver function tests compared with placebo when the Pringle maneuver exceeded 70 min. Larger studies are required to validate our findings and to investigate the specific role of NAC and MET in liver surgery.

AB - Background: The Pringle maneuver, which is performed during liver surgery to reduce blood loss, may result in liver ischemia/reperfusion injury resulting in metabolic, immunological, and microvascular changes, which may lead to hepatocellular damage. The aim of this study was the investigation of the effects of N-acetylcysteine (NAC) and methylprednisolone (MET) in the modulation of liver warm ischemia during hepatic resection. Methods: Forty-eight patients were enrolled in a pilot double-blind, randomized clinical trial. The patients received either NAC, MET, or placebo. The primary endpoint was the reduction in postoperative alanine aminotransferase and bilirubin. The secondary endpoint was the difference in morbidity and mortality. Results: All the 48 patients had liver resection with no mortality. Morbidity was observed in 8 (16 %) patients equally distributed among the groups. There was a significant favorable recovery of liver function tests in patients treated with NAC or MET compared with the placebo when the Pringle maneuver exceeded 70 min. Conclusions: The administration of NAC or MET prior to the Pringle maneuver during hepatic resection is associated with lower postoperative aberration in liver function tests compared with placebo when the Pringle maneuver exceeded 70 min. Larger studies are required to validate our findings and to investigate the specific role of NAC and MET in liver surgery.

UR - http://www.scopus.com/inward/record.url?scp=84964402830&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84964402830&partnerID=8YFLogxK

U2 - 10.1007/s00268-016-3506-1

DO - 10.1007/s00268-016-3506-1

M3 - Article

AN - SCOPUS:84964402830

SP - 1

EP - 11

JO - World Journal of Surgery

JF - World Journal of Surgery

SN - 0364-2313

ER -