Major liver resection results in early exacerbation of insulin resistance, and may be a risk factor of developing overt diabetes in the future

Durczyński, Adam; Strzelczyk, Janusz; Wojciechowska-Durczynska, Katarzyna; Borkowska, Anna; Hogendorf, Piotr; Szymański, Dariusz; Chałubińska, Justyna; Czupryniak, Leszek

doi:10.1007/s00595-012-0268-8

Cited by 10 publications

(16 citation statements)

References 24 publications

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“…However, PEM can significantly increase the operative risk at the time of surgery and is a risk factor for morbidity, short- and long-term mortality in patients undergoing LT [ 7 , 8 ] and decreased graft survival after LT [ 9 ]. Moreover, PEM predisposes a patient to complications such as compromised respiratory function, wound-healing problems, longer dependency on mechanical ventilation, increased rates of septic complications, use of antibiotics, blood products usage, length of hospital stay, intensive care unit admissions, delayed physical rehabilitation, with substantially higher cost of the transplant [ 8 , 9 ]. Prolonged waiting times worsen outcomes when patients are already malnourished [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Body cell mass (BCM) is defined as the sum of intracellular water and fat-free mass, including skeletal muscle and viscera, without bone mineral mass. BCM comprises the metabolically active and protein-rich compartments in the body responsible for basal energy expenditure (BEE) and is known to be depleted in patients with PEM [ 9 ]. Loss of skeletal muscle mass (SMM) or sarcopenia, reflecting preoperative malnutrition is a common complication of liver cirrhosis (LC).…”

Section: Introductionmentioning

confidence: 99%

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Nutritional Therapy in Liver Transplantation

et al. 2017

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Protein-energy malnourishment is commonly encountered in patients with end-stage liver disease who undergo liver transplantation. Malnutrition may further increase morbidity, mortality and costs in the post-transplantation setting. The importance of carefully assessing the nutritional status during the work-up of patients who are candidates for liver replacement is widely recognized. The metabolic abnormalities induced by liver failure render the conventional assessment of nutritional status to be challenging. Preoperative loss of skeletal muscle mass, namely, sarcopenia, has a significant detrimental impact on post-transplant outcomes. It is essential to provide sufficient nutritional support during all phases of liver transplantation. Oral nutrition is preferred, but tube enteral nutrition may be required to provide the needed energy intake. Herein, the latest currently employed perioperative nutritional interventions in liver transplant recipients are thoroughly illustrated including synbiotics, micronutrients, branched-chain amino acid supplementation, immunonutrition formulas, fluid and electrolyte balance, the offering of nocturnal meals, dietary counselling, exercise and rehabilitation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nutritional Therapy in Liver Transplantation

et al. 2017

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“…Preoperative liver dysfunction may correlate with perioperative hyperglycemia 80 . However, liver surgery per se induces insulin resistance, even in non-DM patients without liver failure, as reported by Durzynski et al 81 . In response to the surgical stress during hepatic resection, cytokine levels are increased 82 .…”

Section: Liver Surgerymentioning

confidence: 67%

“…In some studies, with focus on evaluating postoperative outcome, a socalled GIN-or GIK-infusions with glucose and insulin in various combinations, have been used for glucose control 6 . In addition, some investigators have chosen to assess postoperative insulin resistance by indirect measurements, like HOMA-IR 81 . Even though time and labor consuming, we chose the HNC, which is considered the gold standard.…”

Section: Paper III and Iv-effect Of Intraoperative Glucose Control Onmentioning

confidence: 99%

The effect of perioperative glucose control on postoperative insulin resistance

et al. 2012

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“…Hyperglycemia is both a marker and cause of adverse outcomes both for diabetics and non-diabetic patients. The Interleukins released also cause insulin resistance either by suppressing insulin receptors tyrosine kinase activity or reduction of transmembrane glucose transporters expression, leading to hyperglycemia during early postoperative period [84] . It is therefore recommended to initiate insulin therapy early after liver resections in order to maintain normoglycemia [5] .…”

Section: Postoperative Glycemic Controlmentioning

confidence: 99%

Enhanced recovery after surgery in liver surgery

Kumar¹,

Jha²,

Negi³

2018

MIS

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Enhanced recovery after surgery (ERAS) or fast-track surgery protocols, have been implemented across surgical fields with positive impact on outcomes. These protocols represent a standardized and evidence-based multimodal perioperative strategy founded on a series of measures aiming to attenuate the physical and psychological stress responses to surgical insults, and to potentiate the postoperative rehabilitation of patients. The successful adoption of ERAS protocols in various specialties enabled its gradual acceptance in the complex field of liver surgery. Even though many elements have been adapted especially from colorectal surgery, a few elements of ERAS protocol are unique to liver surgery. The goals of enhanced recovery can be achieved with efforts beginning at the first interaction on outpatient basis. Core elements of this multidisciplinary effort include pre-operative counseling, shortened preoperative fasting, no pre-anesthetic medication, targeted antimicrobial prophylaxis and early withdrawal, preventing and treating of postoperative nausea and vomiting, minimally invasive approaches, avoidance of postoperative nasogastric decompression, preventing hypothermia, optimal perioperative fluid management, selective use of abdominal drains, early urinary catheter removal, optimal pain control, early oral feeding and mobilization. The available evidence from recent randomized controlled studies and meta-analyses comparing ERAS programs with traditional care in liver surgery suggests that length of hospital stay is shortened without increasing morbidity, mortality or readmission rates.

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Major liver resection results in early exacerbation of insulin resistance, and may be a risk factor of developing overt diabetes in the future

Cited by 10 publications

References 24 publications

Nutritional Therapy in Liver Transplantation

Nutritional Therapy in Liver Transplantation

The effect of perioperative glucose control on postoperative insulin resistance

Enhanced recovery after surgery in liver surgery

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