Evaluating the Effect of a Low-Calorie Pre-Hepatectomy Diet on Perioperative Outcomes: A Systematic Review & Meta-Analysis

Abstract

Background: Few studies have evaluated potential benefits of pre-operative calorie-restricted diets among patients undergoing hepatectomy. This systematic review aimed to assess the effect of low-calorie pre-hepatectomy diets on perioperative outcomes. Methods: This study was conducted in accordance with the PRISMA and MOOSE guidelines. Following a comprehensive literature search, two reviewers independently screened references and abstracted relevant study details. We included comparative studies of patients undergoing hepatectomy, with some receiving a pre-operative low-calorie diet of any type/duration. Pooled analyses of outcomes were performed where appropriate. Results: The search strategy yielded 210 citations, with 3 studies meeting inclusion criteria (1 randomized trial and 2 retrospective cohort studies; including one study of donor hepatectomies). In all, 243 patients were assessed, with 98 receiving a low-calorie pre-hepatectomy diet. Diet length was 1 week in two of the studies, and a median of 7.3 weeks in the third. Diet compliance was high. Patients receiving a pre-hepatectomy diet demonstrated significantly less steatosis, steatohepatitis, and intraoperative blood loss (mean difference: –319.0 [–486.9, –151.1] mL, p<0.001), compared to controls. One study showed decreased perioperative blood transfusions for patients receiving the low-calorie diet, though not statistically significant. There were no differences in post-operative complications, length of stay, or mortality. Conclusions: Low-calorie pre-hepatectomy diet is an understudied intervention for pre-operative patient optimization. Current literature shows promise, as evidenced by decreased steatosis, intraoperative blood loss, and potentially decreased transfusions. Further prospective trials are necessary to fully appreciate its role in improving perioperative and post-operative outcomes.