title: Metabolic syndrome and hepatic resection: improving outcome.
abstract: OBJECTIVE
  A review of the peri-operative risk associated with hepatic resection in patients with metabolic syndrome (MetS) and identification of measures for the improvement of cardiometabolic disturbances and liver-related mortality.
  
  
  BACKGROUND
  MetS and its hepatic manifestation non-alcoholic fatty liver disease (NAFLD) are associated with an increased operative mortality in spite of a significant improvement in peri-operative outcome after hepatic resection.
  
  
  METHODS
  A review of the English literature on MetS, liver resection and steatosis was performed from 1980 to 2011 using the MEDLINE and PubMed databases.
  
  
  RESULTS
  MetS is a predictor of NAFLD and patients with multiple metabolic risk factors may harbour non-alcoholic steatohepatitis (NASH) predictive of operative and cardiovascular mortality. Pre-operative diagnosis of unsuspected NASH with the selective use of a liver biopsy can modify the operative strategy by limiting the extent of hepatic resection, avoiding or altering the pre-operative chemotherapy regimen and the utilization of portal vein embolization. Thiazolidinediones are therapeutic for MetS and NASH and Vitamin E for active NASH; however, their utility in improving the peri-operative outcome after hepatic resection is unknown. A short-term regimen for weight loss improves post-operative patient and liver-related outcomes in patients with >30% steatosis. Cardiovascular disease associated with MetS or NAFLD should be managed aggressively. Peri-operative measures to minimize thrombotic events and acute renal injury secondary to the pro-inflammatory, prothrombotic state of MetS may further improve the outcome.
  
  
  CONCLUSIONS
  Potential candidates for hepatic resection should be screened for MetS as the pre-operative identification of NASH, short-term treatment of significant steatosis, cardiovascular risk assessment and optimization of each component of MetS may improve the peri-operative outcome in this high-risk subset of patients.
authors.affiliation: Hepatobiliary and Pancreatic Surgery, Department of Gastrointestinal Surgery, Indraprastha Apollo Hospitals, New Delhi, India. shefali_a@apollohospitals.com
authors.forename: Shefali
authors.initials: S
authors.lastname: Agrawal
authors.forename: Cherag
authors.initials: C
authors.lastname: Daruwala
mesh_terms: D005234:Fatty Liver / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D024821:Metabolic Syndrome / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D065626:Non-alcoholic Fatty Liver Disease; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
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