Hepatic protection by perioperative metabolic support?

OBJECTIVE

We report the case of a 63-y-old woman undergoing left hepatectomy for hilar cholangiocarcinoma who was at high risk of postoperative liver failure due to an atrophic right liver lobe. She participated in a randomized clinical trial investigating the effect of perioperative glucose infusion on hepatic function after major liver resection.

METHODS

Intravenous glucose was initiated the night before the operation at 2 mg x kg(-1) x min(-1). During and after the operation, glucose was administered with a continuous insulin infusion until the first postoperative day. Postoperative liver function was assessed by the score proposed by Schindl, evaluating total serum bilirubin and plasma lactate concentrations, prothrombin time, and the grade of encephalopathy.

RESULTS

The patient's liver dysfunction was classified as "mild" on postoperative day 1 and as "none" on postoperative day 2. Postoperative liver function scores were better than those observed in a control group of patients who underwent hepatic resection of similar magnitude without glucose/insulin therapy.

CONCLUSION

Perioperative glucose/insulin administration was associated with a surprisingly small deterioration of liver function after left lobe liver resection in the presence of an atrophic right lobe. A randomized clinical trial will have to determine whether glucose/insulin therapy can improve hepatic function after major liver resections.