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World J Hepatol. May 27, 2014; 6(5): 306-314
Published online May 27, 2014. doi: 10.4254/wjh.v6.i5.306
Metabolic syndrome and non-alcoholic fatty liver disease in liver surgery: The new scourges?
François Cauchy, David Fuks, Alban Zarzavadjian Le Bian, Jacques Belghiti, Renato Costi
François Cauchy, David Fuks, Jacques Belghiti, Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Beaujon, Assistance Publique - Hôpitaux de Paris, 92110 Clichy, France
Alban Zarzavadjian Le Bian, Laboratoire de Recherche en Ethique Médicale et Médecine Légale, Université de Paris 5 Descartes, 75006 Paris, France
Renato Costi, Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Azienda Ospedaliero-Universitaria di Parma, 43100 Parma, Italy
Author contributions: Cauchy F and Costi R designed the research; Cauchy F and Fuks D performed the research; Cauchy F, Fuks D and Zarzavadjian Le Bian A analyzed the data; Cauchy F wrote the paper; Fuks D, Zarzavadjian Le Bian A, Belghiti J and Costi R gave an important intellectual contribution; Belghiti J and Costi R supervised.
Correspondence to: Renato Costi, MD, PhD, FACS, Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100 Parma, Italy.
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Received: November 9, 2013
Revised: January 1, 2014
Accepted: January 17, 2014
Published online: May 27, 2014

The aim of this topic highlight is to review relevant evidence regarding the influence of the metabolic syndrome (MS) and its associated liver manifestation, non-alcoholic fatty liver disease (NAFLD), on the development of liver cancer as well as their impact on the results of major liver surgery. MS and NAFLD, whose incidences are significantly increasing in Western countries, are leading to a changing profile of the patients undergoing liver surgery. A MEDLINE search was performed for relevant articles using the key words “metabolic syndrome”, “liver resection”, “liver transplantation”, “non alcoholic fatty liver disease”, “non-alcoholic steatohepatitis” and “liver cancer”. On one hand, the MS favors the development of primary liver malignancies (hepatocellular carcinoma and cholangiocarcinoma) either through NAFLD liver parenchymal alterations (steatosis, steatohepatitis, fibrosis) or in the absence of significant underlying liver parenchyma changes. Also, the existence of NAFLD may have a specific impact on colorectal liver metastases recurrence. On the other hand, the postoperative period following partial liver resection and liver transplantation is at increased risk of both postoperative complications and mortality. These deleterious effects seem to be related to the existence of liver specific complications but also higher cardio-vascular sensitivity in a setting of MS/NAFLD. Finally, the long-term prognosis after curative surgery joins that of patients operated on with other types of underlying liver diseases. An increased rate of patients with MS/NAFLD referred to hepatobiliary units has to be expected. The higher operative risk observed in this subset of patients will require specific improvements in their perioperative management.

Keywords: Metabolic syndrome, Non-alcoholic fatty liver disease, Non-alcoholic steatohepatitis, Neoplasia, Hepatocarcinoma, Liver surgery, Complications, Morbidity

Core tip: The metabolic syndrome (MS) and its hepatic manifestations, non-alcoholic fatty liver disease (NAFLD), are increasingly observed in Western countries. Both MS and NAFLD could favor the development of primary liver malignancies and may also lead to end-stage liver disease. These patients are at higher operative risk because of underestimated postoperative liver related complications but also specific increase in cardio-vascular complications. Specific improvements in the perioperative management of these patients are required in order to improve the operative results.