Impact of Neutrophil Elastase Inhibitor following Liver Resection

Background: Sivelestat is a neutrophil elastase inhibitor (NEI) that has a good treatment effect on respiratory complications in thoracic surgery. Objectives: To examine the effect of NEI on the postoperative outcomes after liver resection.Methods: The 374 consecutive patients to undergo liver resection was included. Seven perioperative variables were matched on the basis of the patients' background. Then, the NEI group (n=61) and the control group (n=61) were compared. NEI was administered for 3 days on postoperative day 0. The liver function, coagulation activity, inflammatory response and complications were compared.Results: The levels of serum interleukin-6 (NEI group: 113 pg/mL (range: 26.9-522.0) vs. control group: 174 (28.6-1040.6), p=0.01) and C-reactive protein (2.9 IU/L (0.1-8.6) vs. 4.11 (0.3-13.8), p=0.01) on postoperative day 1 and the alveolar-arterial oxygen tension difference (32.3 Torr (-28.6-132.3) vs. 46.6 (-11.2-251.6), p=0.04) on postoperative day 3 were significantly lower in the NEI group. The rate of pleural effusion was significantly lower in the NEI group compared to the control group (13 patients (21.3%) vs. 23 (37.7%), p=0.04). However, the coagulation activities (p=0.68) liver function (p=0.69) and overall complications (p=0.71) did not differ significantly. Conclusions: Intravenous NEI administration was thus found to have a positive effect on the postoperative inflammatory response and oxygenation while it did not affect either coagulation or the liver function as well as severe grade complications.