Lee JZ, Ng SJKK, Shelat VG. Metabolic changes after hepatectomy: Implications for perioperative management and long-term outcomes. World J Gastrointest Pathophysiol 2025; 16(4): 109860 [DOI: 10.4291/wjgp.v16.i4.109860]
Corresponding Author of This Article
Vishal G Shelat, Adjunct Associate Professor, FRCS, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. vgshelat@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
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Systematic Reviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 22, 2025 (publication date) through Dec 22, 2025
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World Journal of Gastrointestinal Pathophysiology
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2150-5330
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Lee JZ, Ng SJKK, Shelat VG. Metabolic changes after hepatectomy: Implications for perioperative management and long-term outcomes. World J Gastrointest Pathophysiol 2025; 16(4): 109860 [DOI: 10.4291/wjgp.v16.i4.109860]
World J Gastrointest Pathophysiol. Dec 22, 2025; 16(4): 109860 Published online Dec 22, 2025. doi: 10.4291/wjgp.v16.i4.109860
Metabolic changes after hepatectomy: Implications for perioperative management and long-term outcomes
Joshua Zhuo Lee, Sandra Joanne Kar Kwan Ng, Vishal G Shelat
Joshua Zhuo Lee, Department of Medicine, Lee Kong Chian School of Medicine, Singapore 308232, Singapore
Sandra Joanne Kar Kwan Ng, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
Vishal G Shelat, Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
Author contributions: Shelat VG conceptualized and designed the study, supervised, and made critical revisions; Lee JZ conducted the literature review, consolidated the data, drafted the original manuscript, and made critical revisions; Ng SJKK conducted the literature review; all authors contributed to preparation of the draft and approved the submitted version.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vishal G Shelat, Adjunct Associate Professor, FRCS, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. vgshelat@gmail.com
Received: May 26, 2025 Revised: July 12, 2025 Accepted: October 30, 2025 Published online: December 22, 2025 Processing time: 212 Days and 21.9 Hours
Abstract
BACKGROUND
Hepatectomy triggers complex metabolic changes as the liver adapts to the loss of functional mass and initiates regeneration. These changes impact carbohydrate, lipid, and protein metabolism, as well as energy and oxygen dynamics. A deeper understanding of these shifts is essential for improving perioperative management and enhancing long-term outcomes.
AIM
To review and synthesise the current understanding of metabolic changes following hepatectomy and explore their implications for perioperative care, postoperative recovery, and long-term patient outcomes.
METHODS
A narrative review was conducted using PubMed, Cochrane, and Scopus databases to identify relevant human studies published up to December 2024. Search terms included “hepatectomy”, “liver resection”, “metabolic changes”, and related phrases. Studies focusing on metabolic adaptations—specifically changes in glucose, lipid, protein metabolism, and energy consumption—were included.
RESULTS
Hepatectomy induces a shift toward gluconeogenesis and transient insulin resistance, increased lipid oxidation, amino acid imbalance, and a heightened inflammatory response, especially during ischaemia-reperfusion injury. These changes vary with the extent of resection and the presence of underlying liver disease. Novel insights include the role of the physiologic Pringle manoeuvre (a pharmacologic alternative to mechanical clamping) and metabolomic biomarkers for assessing surgical risk and liver regeneration.
CONCLUSION
Understanding the metabolic adaptations following hepatectomy provides an opportunity to optimise perioperative care strategies such as nutrition, glucose and lipid management, and mitigation of ischaemia-reperfusion injury. Integrating these insights may enhance surgical outcomes, particularly in patients with hepatocellular carcinoma or non-alcoholic fatty liver disease.
Core Tip: This narrative review explores the intricate metabolic adaptations following hepatectomy, emphasising the shift towards gluconeogenesis and transient insulin resistance, increased lipid oxidation, imbalance in amino acids, and a heightened inflammatory response (especially in ischaemic reperfusion injury). It highlights the role of the liver in maintaining systemic metabolic homeostasis, and how surgical disruption affects liver metabolism. Metabolic changes post-hepatectomy influence recovery, and may serve as targets for optimising recovery, thereby guiding and enhancing perioperative care and ultimately improving surgical outcomes.
