Preoperative fasting improves survival after 90% hepatectomy

Area of Science:

• Hepatology
• Metabolic Surgery
• Surgical Oncology

Background:

• Major hepatectomy necessitates understanding metabolic adaptations for optimal patient outcomes.
• Fasting alters substrate utilization, potentially impacting post-surgical liver recovery.
• Gluconeogenesis and fatty acid oxidation are key metabolic pathways influenced by fasting.

Purpose of the Study:

• To investigate the impact of fasting-induced metabolic changes on survival and liver regeneration after 90% hepatectomy in rats.
• To assess how preoperative fasting and postoperative glucose administration affect key metabolic markers and liver function.

Main Methods:

• A randomized controlled trial involving 157 Wistar rats undergoing 90% hepatectomy.
• Two groups: 24-hour preoperative fast vs. fed ad libitum.
• Postoperative randomization to receive either 20% glucose or tap water.
• Serial quantification of survival, hepatic DNA synthesis, glucokinase activity, glycogen, ketone bodies, free fatty acids, and glucose consumption.

Main Results:

• Fasting pre-hepatectomy followed by postoperative glucose significantly improved 48-hour survival (95% vs. 52%) and peak DNA synthesis compared to fed rats.
• Postoperative glucose administration was crucial; survival was poor with tap water only (31% vs. 12%).
• Fasting increased post-hepatectomy glucose consumption and elevated free fatty acids and ketone bodies, while suppressing glucokinase activity.

Conclusions:

• Preoperative fasting shifts energy metabolism towards fat oxidation and gluconeogenesis.
• This metabolic shift appears to mitigate liver failure following extensive hepatectomy.
• The findings suggest a potential preconditioning strategy to improve outcomes in severe hepatic resection models.