Hepatic steatosis in patients undergoing resection of colorectal liver metastases: A target for prehabilitation? A narrative review
| Autor: | L. Rimmer, A. Krige, S. Lapsia, D.T. Doherty, P.O. Coe, Daren Subar |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Prehabilitation medicine.medical_treatment Population 030230 surgery Gastroenterology 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Preoperative Care medicine Hepatectomy Humans Risk factor education education.field_of_study Chemotherapy business.industry Liver Neoplasms medicine.disease Fatty Liver Oncology 030220 oncology & carcinogenesis Cohort Etiology Surgery Steatosis Steatohepatitis business Colorectal Neoplasms |
| Zdroj: | Surgical oncology. 30 |
| ISSN: | 1879-3320 |
| Popis: | The prevalence of elevated intra-hepatic fat (IHF) is increasing in the Western world, either alone as hepatic steatosis (HS) or in conjunction with inflammation (steatohepatitis). These changes to the hepatic parenchyma are an independent risk factor for post-operative morbidity following liver resection for colorectal liver metastases (CRLM). As elevated IHF and colorectal malignancy share similar risk factors for development it is unsurprisingly frequent in this cohort. In patients undergoing resection IHF may be elevated due to excess adiposity or its elevation may be induced by neoadjuvant chemotherapy, termed chemotherapy associated steatosis (CAS). Additionally, chemotherapy is implicated in the development of inflammation termed chemotherapy associated steatohepatitis (CASH). Following cessation of chemotherapy, patients awaiting resection have a 4-6 week washout period prior to resection that is a window for prehabilitation prior to surgery. In patients with NAFLD dietary and pharmacological interventions can reduce IHF within this timeframe but this approach to modifying IHF is untested in this population. In this review, the aetiology of CAS and CASH is reviewed with recommendations to identify those at risk. We also focus on the post-chemotherapy washout period, reviewing dietary interventions applied to the metabolic population and suggest this window may be used as an opportunity to optimise IHF with such a regime as part of a pre-operative prehabilitation programme to produce improved patient outcomes. |
| Databáze: | OpenAIRE |
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