Metabolic changes after hepatectomy: Implications for perioperative management and long-term outcomes

Hepatectomy triggers complex metabolic changes as the liver adapts to the loss of functional mass and initiates regeneration. These changes impact carbohydrate, lipid, and protein metabolism, as well as energy and oxygen dynamics. A deeper understanding of these shifts is essential for improving perioperative management and enhancing long-term outcomes.

To review and synthesise the current understanding of metabolic changes following hepatectomy and explore their implications for perioperative care, postoperative recovery, and long-term patient outcomes.

A narrative review was conducted using PubMed, Cochrane, and Scopus databases to identify relevant human studies published up to December 2024. Search terms included "hepatectomy", "liver resection", "metabolic changes", and related phrases. Studies focusing on metabolic adaptations-specifically changes in glucose, lipid, protein metabolism, and energy consumption-were included.

Hepatectomy induces a shift toward gluconeogenesis and transient insulin resistance, increased lipid oxidation, amino acid imbalance, and a heightened inflammatory response, especially during ischaemia-reperfusion injury. These changes vary with the extent of resection and the presence of underlying liver disease. Novel insights include the role of the physiologic Pringle manoeuvre (a pharmacologic alternative to mechanical clamping) and metabolomic biomarkers for assessing surgical risk and liver regeneration.

Understanding the metabolic adaptations following hepatectomy provides an opportunity to optimise perioperative care strategies such as nutrition, glucose and lipid management, and mitigation of ischaemia-reperfusion injury. Integrating these insights may enhance surgical outcomes, particularly in patients with hepatocellular carcinoma or non-alcoholic fatty liver disease.