Preoperative dexamethasone administration in hepatectomy of 25-min intermittent Pringle’s maneuver for hepatocellular carcinoma: a randomized controlled trial

BACKGROUND: A previous randomized controlled trial demonstrated that intermittent Pringle’s maneuver (IPM) with a 25-min ischemic interval could be applied safely and efficiently in hepatectomy for patients with hepatocellular carcinoma (HCC). But prolonging the hepatic inflow clamping time will inevitably aggravate the ischemia-reperfusion injury. Therefore, we aimed to evaluate the effect of prophylactic dexamethasone on alleviating surgical stress for HCC patients with a 25-min ischemic interval. METHODS: From December 2022 to April 2023, patients who met the inclusion criteria were randomly assigned to the dexamethasone group or control group. Perioperative data and short-term survival outcomes between the two groups were recorded and compared, and subgroup analysis was performed. RESULTS: Two hundred and seventy patients were allocated to the dexamethasone group (n=135) and control group (n=135). Patients in the dexamethasone group had lower area under the curve of serial alanine aminotransferase (AUC(ALT)) (P=0.043) and aspartate aminotransferase (AUC(AST)) (P=0.009), total bilirubin (TB) (P=0.018), procalcitonin (PCT) (P=0.012), interleukin-6 (IL-6) (P=0.006), incidence of major complication (P=0.031) and shorter postoperative hospital stay (P=0.046) than those in the control group. Subgroup analysis showed that the dexamethasone group experienced milder hepatocellular injury than the control group for patients with cirrhosis, and for patients without cirrhosis, the dexamethasone group experienced milder inflammatory response. Moreover, the dexamethasone group preserved better liver function and experienced milder inflammatory response for patients undergoing major hepatectomy, although the hepatocellular injury was not significantly improved. CONCLUSION: Preoperative dexamethasone administration can help improve perioperative outcomes for HCC patients when applying IPM with a 25-min ischemic interval in hepatectomy.