title: Implementation of molecular phenotyping approaches in the personalized surgical patient journey.
abstract: OBJECTIVE
  The present review describes commonly employed metabolic profiling platforms and discusses the current and likely future application of these technologies in surgery.
  
  
  BACKGROUND
  The metabolic adaptations that occur in response to surgical illness and trauma are incompletely understood. Evaluating these will be critical to the development of personalized surgical health solutions. Metabonomics is an advancing field in systems biology, which provides a means of interrogating these metabolic shifts.
  
  
  METHODS
  Recent literature regarding metabolic profiling technologies and their applications in surgical practice are discussed. Future strategies are proposed for the incorporation of these and next-generation technologies in the evaluation of all steps in the patient surgical pathway.
  
  
  RESULTS
  Metabolite-based profiling has provided valuable insights into the metabolic irregularities that occur in cancer development and progression across a variety of cancer subclasses including colorectal, breast, prostate, and lung cancers. In addition, metabolic modeling has shown considerable promise in other surgical conditions including trauma and sepsis and in the assessment of pharmacotherapeutic efficacy.
  
  
  CONCLUSIONS
  Metabonomics offers a posttranscriptional view of system activity providing functional information downstream of the genome and proteome. Information at this level will provide the surgeon with a novel means of evaluating major socioeconomic problems such as cancer and sepsis. In addition, the rapid nature of emerging next generation profiling platforms provides a viable means of "real-time" perioperative metabolic assessment and optimization.
authors.affiliation: Section of Biosurgery and Surgical Technology, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, QEQM, St Mary's Hospital, London, United Kingdom.
authors.forename: Reza
authors.initials: R
authors.lastname: Mirnezami
authors.forename: James M
authors.initials: JM
authors.lastname: Kinross
authors.forename: Panagiotis A
authors.initials: PA
authors.lastname: Vorkas
authors.forename: Robert
authors.initials: R
authors.lastname: Goldin
authors.forename: Elaine
authors.initials: E
authors.lastname: Holmes
authors.forename: Jeremy
authors.initials: J
authors.lastname: Nicholson
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D001943:Breast Neoplasms / Q000378:metabolism; D002471:Cell Transformation, Neoplastic / Q000378:metabolism; D015179:Colorectal Neoplasms / Q000378:metabolism; D005260:Female; D020869:Gene Expression Profiling; D013502:General Surgery / Q000639:trends*; D006801:Humans; D016018:Least-Squares Analysis; D008175:Lung Neoplasms / Q000378:metabolism; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D013058:Mass Spectrometry; D055442:Metabolome / Q000502:physiology; D055432:Metabolomics; D009369:Neoplasms / Q000378:metabolism* / Q000601:surgery; D059035:Perioperative Period; D057285:Precision Medicine / Q000639:trends*; D011471:Prostatic Neoplasms / Q000378:metabolism; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; D013312:Stress, Physiological / Q000502:physiology; D014947:Wounds and Injuries / Q000378:metabolism