Preoperative 1-week diet can markedly decrease blood loss during hepatectomy

Great effort has been paid to decrease blood loss during hepatectomy. Excessive blood loss and/or allogeneic blood transfusion can cause an increased risk of perioperative morbidity and mortality and may lead to a greater risk of early tumor recurrence (1-4). Hepatic steatosis or steatohepatitis is present in 30–50% of patients in the Western countries and can increase blood loss and morbidity in patients undergoing hepatectomy for colorectal liver metastases (5-7). Steatotic livers are hypertrophic and delicate and are therefore more difficult to mobilize or transect compared to nonsteatotic livers. Bariatric surgeons routinely prescribe a low-fat diet for 2 weeks before laparoscopic bariatric surgery to make it easier to retract the liver (8). To date, no studies have described whether preoperative diet can improve the difficulty of liver surgery. The author’s study group previously demonstrated the effect of a 1-week low-calorie and low-fat diet on histological findings of hepatic steatosis and the surgical outcomes after liver resection in a retrospective comparative study (9)