TY - JOUR
T1 - Short-term Preoperative Diet Decreases Bleeding after Partial Hepatectomy
T2 - Results from a Multi-institutional Randomized Controlled Trial
AU - Barth, Richard J.
AU - Mills, Jeannine B.
AU - Suriawinata, Arief A.
AU - Putra, Juan
AU - Tosteson, Tor D.
AU - Axelrod, David
AU - Freeman, Richard
AU - Whalen, Giles F.
AU - LaFemina, Jennifer
AU - Tarczewski, Susan M.
AU - Kinlaw, William B.
N1 - Funding Information:
From the *Departments of Surgery, Dartmouth-Hitchcock Medical Center, Leb-anon, NH; †Departments of Radiation Oncology, Dartmouth-Hitchcock Med-ical Center, Lebanon, NH; zDepartments of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; §Departments of Biomedical Data Science, Dartmouth-Hitchcock Medical Center, Lebanon, NH; ôDepartment of Sur-gery, University of Massachusetts Medical Center, Worcester, MA; and ||Departments of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Disclosure: This study was supported by a grant from the Norris Cotton Cancer Center. The authors declare no conflicts of interest. Reprints: Richard J. Barth Jr, MD, Section of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756; E-mail: [email protected]. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0003-4932/18/26901-0048 DOI: 10.1097/SLA.0000000000002709
Publisher Copyright:
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Background: Our previous case series suggested that a 1-week, low-calorie and low-fat diet was associated with decreased intraoperative blood loss in patients undergoing liver surgery. Objective: The current study evaluates the effect of this diet in a randomized controlled trial. Methods: We randomly assigned 60 patients with a body mass index ≥25 kg/m2 to no special diet or an 800-kcal, 20 g fat, and 70 g protein diet for 1 week before liver resection. Surgeons were blinded to diet assignment. Hepatic glycogen stores were evaluated using periodic acid Schiff (PAS) stains. Results: Ninety four percent of the patients complied with the diet. The diet group consumed fewer daily total calories (807 vs 1968 kcal, P < 0.001) and fat (21 vs 86 g, P < 0.001) than the no diet group. Intraoperative blood loss was less in the diet group: mean blood loss 452 vs 863 mL (P = 0.021). There was a trend towards decreased transfusion in the diet group (138 vs 322 mL, P = 0.06). The surgeon judged the liver to be easier to manipulate in the diet group: 1.86 versus 2.90, P = 0.004. Complication rate (20% vs 17%), length of stay (median 5 vs 4 days) and mortality did not differ between groups. There was no difference in hepatic steatosis between groups. There was less glycogen in hepatocytes in the diet group (PAS stain score 1.61 vs 2.46, P < 0.0001). Conclusions: A short-course, low-fat, and low-calorie diet significantly decreases bleeding and makes the liver easier to manipulate in hepatic surgery.
AB - Background: Our previous case series suggested that a 1-week, low-calorie and low-fat diet was associated with decreased intraoperative blood loss in patients undergoing liver surgery. Objective: The current study evaluates the effect of this diet in a randomized controlled trial. Methods: We randomly assigned 60 patients with a body mass index ≥25 kg/m2 to no special diet or an 800-kcal, 20 g fat, and 70 g protein diet for 1 week before liver resection. Surgeons were blinded to diet assignment. Hepatic glycogen stores were evaluated using periodic acid Schiff (PAS) stains. Results: Ninety four percent of the patients complied with the diet. The diet group consumed fewer daily total calories (807 vs 1968 kcal, P < 0.001) and fat (21 vs 86 g, P < 0.001) than the no diet group. Intraoperative blood loss was less in the diet group: mean blood loss 452 vs 863 mL (P = 0.021). There was a trend towards decreased transfusion in the diet group (138 vs 322 mL, P = 0.06). The surgeon judged the liver to be easier to manipulate in the diet group: 1.86 versus 2.90, P = 0.004. Complication rate (20% vs 17%), length of stay (median 5 vs 4 days) and mortality did not differ between groups. There was no difference in hepatic steatosis between groups. There was less glycogen in hepatocytes in the diet group (PAS stain score 1.61 vs 2.46, P < 0.0001). Conclusions: A short-course, low-fat, and low-calorie diet significantly decreases bleeding and makes the liver easier to manipulate in hepatic surgery.
KW - bleeding
KW - hepatectomy
KW - hepatic glycogen
KW - liver maneuverability
KW - liver manipulation
KW - liver surgery
KW - steatosis
KW - very low-calorie diet
UR - http://www.scopus.com/inward/record.url?scp=85058887978&partnerID=8YFLogxK
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U2 - 10.1097/SLA.0000000000002709
DO - 10.1097/SLA.0000000000002709
M3 - Article
C2 - 29489484
AN - SCOPUS:85058887978
SN - 0003-4932
VL - 269
SP - 48
EP - 52
JO - Annals of surgery
JF - Annals of surgery
IS - 1
ER -