A pre-operative two-week very low-calorie diet to reduce steatosis before liver resection (RESOLVE): A multi-centre randomised controlled feasibility trial.

BACKGROUND

Liver surgery (LS) remains the main curative option for liver metastases and primary liver tumours. Low-calorie and very low-calorie diets (VLCDs) are routinely used for 2-4 weeks prior to bariatric and gallbladder surgery to reduce liver size and abdominal adiposity, thereby improving surgical safety. This study aimed to evaluate the feasibility of a VLCD in patients undergoing LS with hepatic steatosis (HS).

METHODS

In this randomised controlled feasibility trial, 29 participants were randomised to either the intervention group (VLCD providing 800 kcal and 80 g protein for 2 weeks before LS; n = 14) or treatment as usual (n = 15). Feasibility and clinical outcomes, including operating time, blood loss, ease of surgery, length of hospital stay, readmission and mortality, were assessed.

RESULTS

There was no indication of a between-group difference. There was no mortality within 90 days. In the intervention group, 11 participants initiated VLCD and 6 adhered to it for at least 10 days.

DISCUSSION: Although this feasibility study did not demonstrate a clinical benefit due to the small sample size, a definitive trial is needed to evaluate whether a VLCD administered 2 weeks before LS reduces HS during the preoperative period.

TRIAL REGISTRATION: ISRCTN Number 19701345. Date registered: 20/032023. URL: https://www.isrctn.com/ISRCTN19701345.