Postoperative Nutritional Support in Liver Surgery. Effects of Specialized Parenteral Nutrition Enriched with Branched-Chain Amino Acids Following Liver Resections for Colorectal Carcinoma Metastases

Overview

Introduction:
Perioperative nutritional support in liver surgery remains specific regarding the role of the liver in the metabolism regulation. The loss of functional liver tissue following resection procedures may result in significant metabolic disorders, particularly in patients with preoperative liver impairment in chronic conditions. Perioperative nutritional support is indicated in patients suffering from malnutrition, chronic liver disorders and also following liver resections with limiting residual parenchyma.

Aim of the Study:
The retrospective study assessed the effect of complete parenteral nutrition enriched with branched –chain amino acids on liver function and the rate of postoperative complications following liver resections (of at least two segments) for colorectal carcinoma metastases.

Subjects and Methodology:
142 subjects following liver resections for colorectal carcinoma metastases were included in the study. In 42 subjects with anatomical resections of at least two segments, complete parenteral nutrition enriched with branched- chain amino acids (3.8 g) was administered postoperatively from Day 1. The parenteral nutrition was maintained for 5 to 7 days, from Day 3, additional oral diet regime was indicated. In 100 subjects with a single segment resections or wedge resections, a combination of glucose 10% and crystalloid solutions was administered from Day 1, and early oral diet was added from Day2. Liver tests were performed during the first postoperative week and protein electrophoresis 14 days postoperatively.

Results:
During the first postoperative week, the liver test values reached normal values in patients with specialized complete parenteral nutrition. In subjects, where the specialized parenteral nutrition was not administered, increased alcaline phosphatase levels and gamma glutamyl transpherase levels were recorded through the postoperative Day 7. No significant differences were detected in protein electrophoresis values and in rates of postoperative complications (14 % in both patient groups). Liver test values in specialized nutritional support patients were negatively affected by the extent of their liver resections and occurrence of additional extra hepatic disorders. Administration of complete parenteral nutrition enriched with branched- chain amino acids proved a positive effect on the liver test values recovery.

Conclusion:
Postoperative parenteral nutrition with solutions enriched with branched-chain amino acids in major liver resections (at least 2 segments) has a positive impact on the liver test values recovery during the early postoperative period.

Key words :
liver resection – specialized parenteral nutrition with branched- chain amino acids