The learning curve of laparoscopic liver resection: smooth and idealized with continuous improvement or true?

Abstract

network analysis and compared to metabolites predicting ACLF in an independent cohort of cirrhotic patients. Results: Metabolic profiling could be achieved in 30 minutes. It predicted FLF with an excellent accuracy (Q 2 =0.516) with a sensibility of 100%. Intrahepatic content in neoglucogenic amino acids (alanine, isoleucine, glutamine and valine; p< 0.05) was significantly higher in patients experiencing FLF as well as low glycerophosphocholine (AUROC=0.856; IC95% 0.738-0.974) and high choline/glycerophosphocholine ratio (p=0.011). The metabolic changes identified in this population were different from those observed in ACLF patients. The changes are consistent with Warburg effect that is observed in multicellular proliferating systems. Conclusion: HR-MAS-NMR metabolomics is a powerful tool to predict liver failure after hepatectomy and is clinically relevant given its real-time application. The identified metabolic derangements could lead to evaluate metabolic intervention to prevent liver failure.