Hepatic protection by perioperative metabolic support?

Area of Science:

• Hepatobiliary surgery
• Gastroenterology
• Clinical nutrition

Background:

• Hilar cholangiocarcinoma necessitates major liver resection, posing a risk of postoperative liver failure, especially with pre-existing conditions like an atrophic liver lobe.
• Patients undergoing major liver resection are at high risk for hepatic decompensation.

Observation:

• A 63-year-old woman with an atrophic right liver lobe underwent left hepatectomy for hilar cholangiocarcinoma.
• She was enrolled in a clinical trial for perioperative glucose infusion therapy.

Findings:

• The patient received intravenous glucose (2 mg x kg(-1) x min(-1)) preoperatively, intraoperatively, and postoperatively with continuous insulin infusion.
• Postoperative liver function, assessed using the Schindl score (serum bilirubin, lactate, prothrombin time, encephalopathy), was classified as mild on postoperative day 1 and none on postoperative day 2.
• Liver function scores were superior to those in a control group that did not receive glucose/insulin therapy.

Implications:

• Perioperative glucose/insulin administration demonstrated a minimal impact on liver function following extensive liver resection in a patient with compromised liver reserve.
• Further randomized clinical trials are warranted to validate the efficacy of glucose/insulin therapy in improving hepatic function after major liver resections.