Nutritional Support after Open Liver Resection: A Systematic Review

Abstract

Background: Perioperative nutrition in patients with limited liver function after partial hepatic resection is still controversial. In particular, the significance of perioperative total enteral nutrition remains unresolved. The aim of this review is to investigate the impact of early postoperative total enteral nutrition on convalescence after partial liver resection. Materials and Methods: In an internet-based Medline-Search (time course: 1960–08/2005) a total of five prospective, randomized controlled trials were found comparing the impact of enteral and parenteral nutrition after liver resection. After study validity had been established, a systematic review was undertaken (odds ratio, 95% confidence interval, p < 0.05 level of significance; Review Manager 4.2®, The Cochrane Collaboration). Primary endpoints were complication rate (infection, organ malfunction) and mortality. Standardized immune parameters were also surveyed. Results: Statistical analysis showed that enteral nutrition resulted in a significantly lower rate (p = 0.04) of wound infection and catheter-related complications than parenteral nutrition did. No statistically significant differences in mortality due to enteral or parenteral nutrition could be found. Patients receiving enteral nutrition showed better postoperative immune competence. Conclusion: Early enteral nutrition after liver resection is a safe procedure. Compared to parenteral nutrition it is associated with a decreased incidence of postoperative complications. Facing the inhomogeneity of these trials, especially in nutrition protocols and end points, this first systematic review stresses the need for an update of the importance of early enteral nutrition after liver resection within randomized controlled multicenter trials.

Branched-chain amino acids in liver diseases

“…Furthermore, combinations of BCAAs and angiotensin-converting enzyme inhibitors may prevent the development of HCC in patients with insulin resistance [71] . Perioperative nutritional support, especially enteral rather than parental nutrition, was found to improve the prognosis of cirrhotic patients by reducing complications following hepatectomy [72,73] . Recently, a randomized trial showed that BCAA supplementation after hepatectomy promoted rapid improvement in protein metabolism and inhibited progression to liver cirrhosis [74] .…”

Perioperative Nutrition in Elective Gastrointestinal Surgery – Potential for Improvement?

“…In contrast to the quite numerous studies following colorectal procedures, less is known about the outcome of early oral nutrition following major upper gastrointestinal surgery [37]. Early oral feeding (within 48 h) following gastrectomy did not seem to increase morbidity and shortened the length of hospital stay [38,39,40].…”

“…Early oral feeding (within 48 h) following gastrectomy did not seem to increase morbidity and shortened the length of hospital stay [38,39,40]. When reviewing five prospective, randomized controlled clinical trials, totally including 333 patients, on early enteral nutrition following liver resection, this management was shown to be both safe and associated with a lower incidence of postoperative complications [37]. …”

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“…20 However, most of our donors could not tolerate enteral feeding immediately after major hepatectomy. Thus, temporary PPN support provided alternate nutritional support in these donors early after surgery.…”