Metabolic syndrome and hepatic surgery - 16/06/20
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Highlights |
• | Non-alcoholic fatty liver disease (NAFLD), a hepatic manifestation of metabolic syndrome, currently represents a major problem in liver disease. |
• | Metabolic syndrome and NAFLD are major risk factors for the development of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. |
• | Non-alcoholic steatohepatitis (NASH) is becoming the most frequent cause of liver transplantation in Western countries. |
• | Patients with metabolic syndrome and/or NAFLD are subject to heightened operative risk after liver resection and transplantation and need to be provided with adequately targeted evaluation and perioperative management. |
Summary |
In Europe, the prevalence of metabolic syndrome (MS) has reached the endemic rate of 25%. Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of MS. Its definition is histological, bringing together the different lesions associated with hepatic steatosis (fat deposits on more than 5% of hepatocytes) without alcohol consumption and following exclusion of other causes. MS and NAFLD are implicated in the carcinogenesis of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). At present, HCC and ICC involving MS represent 15–20% and 20–30% respectively of indications for hepatic resection in HCC and ICC. Moreover, in the industrialized nations NAFLD is tending to become the most frequent indication for liver transplantation. MS patients combine the operative risk associated with their general condition and comorbidities and the risk associated with the presence and/or severity of NAFLD. Following hepatic resection in cases of HCC and ICC complicating MS, the morbidity rate ranges from 20 to 30%, and due to cardiovascular and infectious complications, post-transplantation mortality is heightened. The operative risk incurred by MS patients necessitates appropriate management including: (i) precise characterization of the subjacent liver; (ii) an accurately targeted approach privileging detection and optimization of treatment taking into account the relevant cardiovascular risk factors; (iii) a surgical strategy adapted to the histology of the underlying liver, with optimization of the volume of the remaining (postoperative) liver.
Le texte complet de cet article est disponible en PDF.Keywords : Metabolic syndrome, Nonalcoholic fatty liver diseases, Hepatocellular carcinoma, Hepatic resection, Liver transplant
Plan
Vol 157 - N° 3
P. 231-238 - juin 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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