Inflammatory response and oxidative stress during liver resection
Open accessAbstract
BACKGROUND: Postoperative complications are still a major concern after liver resection (LR). Systemic inflammation and deregulated reactive oxygen species during major abdominal surgery may impair outcome after hepatectomy. METHODS: Patients undergoing LR were included in this study (n = 40). Oxidative stress (OS) was measured peri- and post-operatively as static oxidation-reduction potential markers (sORP) and antioxidant capacity ORP (cORP) by using the RedoxSYS Diagnostic system. Furthermore, Th1- and Th2-specific cytokines were assessed. RESULTS: Whereas there was no significant change in systemic sORP during LR and in the early postoperative course, there was a substantial decrease of cORP immediately post-surgery, and on postoperative days 1 and 3 (p<0.001). OS response was tightly regulated, as there was a significant correlation between sORP and cORP (p<0.0001; R2:0.457). An increase of OS (sORP) after LR of more than 3 mV was predictive for severe postoperative complications (53.8% vs. 12.5; p = 0.017). There was a significantly higher IL-2 (p = 0.006) and IL-5 (p = 0.001) increase during hepatectomy in patients who developed a severe morbidity. CONCLUSION: Antioxidant capacity remained stable during LR but dropped during the post-surgical period, suggesting a consumption of antioxidants to maintain OS within healthy range. Severe postoperative complications were associated with a pronounced inflammatory response during surgery.
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The included studies were all prospective single-center observational cohort studies, except for five partly secondary analyses of RCTs with comparably low numbers of patients and potential statistical limitations.
“These studies (all published between 2001 and 2023) were all prospective single-center observational cohort studies, except for five (partly secondary analysis of) RCTs with comparably low numbers of patients and potential statistical limitations [24,25,26,27,28].”
From The Role of Perioperative Interleukin-6 Serum Levels on Liver Dysfunction and Infectious Complications After Hepatectomy—A Systematic Review (2025) · cites this paper as [27]
The citation is attached to the sentence’s exception for five RCTs, but this paper identifies itself in Material and methods as a prospective observational study at the Medical University of Vienna, not an RCT or a secondary analysis of one. Its Results report 40 patients, and its Discussion acknowledges that the sample is relatively small; those details do not resolve the contrary study-design classification. (LLM, conf=0.88)
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Experimental — accuracy not yet measuredThe review included 12 publications with a collective 589 patients, with a range of 14 to 128 patients.
“A final number of 12 publications with a collective 589 patients (range 14–128) were included in this review (Table 1) [20,21,22,23,24,25,26,27,28,29,30,31].”
From The Role of Perioperative Interleukin-6 Serum Levels on Liver Dysfunction and Infectious Complications After Hepatectomy—A Systematic Review (2025) · cites this paper as [27]
In Schwarz et al. 2017, patients experiencing severe complications had significantly higher IL-6 levels on POD3 compared to patients without severe morbidity.
“They discovered that patients experiencing severe complications had significantly higher IL-6 levels on POD3 compared to patients without severe morbidity.”
From The Role of Perioperative Interleukin-6 Serum Levels on Liver Dysfunction and Infectious Complications After Hepatectomy—A Systematic Review (2025) · cites this paper as [27]
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Matsumoto, S., Kuribayashi, Y., Makino, T., et al. (2025) · Cureus · doi:10.7759/cureus.95199
“It is known that perioperative oxidative stress may increase the risk of postoperative complications and delay postoperative recovery [1,9,10].”
Stevens, J. L., McKenna, H., Filipe, H., Lau, L. C. K., Fernandez, B. O., Murray, A. J., Feelisch, M., & Martín, D. (2024) · Figshare · doi:10.6084/m9.figshare.26603311
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- Authors
- Schwarz, C., Fitschek, F., Bar-Or, D., Klaus, D. A., Tudor, B., Fleischmann, E., Roth, G., Tamandl, D., Wekerle, T., Gnant, M., Bodingbauer, M., & Kaczirek, K.
- Affiliations
- Medical University of Vienna (AT)
- Corresponding author
- Kaczirek, Klaus
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2017-10-18
- Volume
- 12
- Issue
- 10
- Pages
- e0185685
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5646773
- OpenAlex
- W2766779582
- Semantic Scholar
- 63d51ffc62d4bc3794fca394159ef8af052684ca
- Cited by
- 47
- References
- 38
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 10 · 2023: 6 · 2022: 6 · 2021: 4 · 2020: 6 · 2019: 7 · 2017: 1
- FWCI
- 2.59
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Covidien
- Topics
- Health Sciences › Medicine › Biochemistry › Antioxidant Activity and Oxidative Stress
- Health Sciences › Medicine › Rehabilitation › Exercise and Physiological Responses
- Health Sciences › Medicine › Psychiatry and Mental health › Cancer, Stress, Anesthesia, and Immune Response
- Keywords
- hepatectomy, oxidative stress, systemic inflammation, redox potential, antioxidant capacity, postoperative complications, Th1 cytokines, Th2 cytokines, interleukin-2, IL-5
- MeSH terms
- Adult, Aged, Female, Hepatectomy, Humans, Inflammation, Liver, Male, Middle Aged, Postoperative Complications, Cytokines, Oxidative Stress
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