Liver Metastasis Colon Cancer, Liver Steatoses, NAFLD
Conditions
Keywords
ketogenic diet, NAFLD, colorectal liver metastases
Brief summary
Non-alcoholic fatty liver disease is becoming increasingly common in Canada and throughout the world. Fatty liver can increase the risks of perioperative complications for those who need liver surgery. A ketogenic diet is low in carbohydrates and can be very effective in reducing liver fat content. The purpose of this randomized control trial is to compare the effect of a short duration (4 week) preoperative ketogenic diet on operative and disease outcomes in patients undergoing liver surgery. One arm will be randomized to the ketogenic diet and the other will receive standard of care pre-operative dietary consultation.
Detailed description
The rise in obesity has contributed to increasing rates of non-alcoholic fatty liver disease (NAFLD) in Canada and globally. In the setting of liver surgery, fatty liver has been associated with higher rates of blood loss during surgery as well as higher rates of postoperative complications. A pre-operative ketogenic diet (KD) has been proposed as a strategy to decrease the risks of fatty liver in patients undergoing liver surgery and has shown promising results in reducing liver fat content, even with short-duration diets. The current literature contains a large variety of pre-operative diets aimed at reducing liver fat content and most studies are observational. Presently, there is no randomized control trial looking at the effects of a well-formulated and standardized KD prior to liver surgery and its effect on operative and disease outcomes. This study will randomize patients with NAFLD needing surgery to remove liver tumors to either the control group or intervention group. Patients in the control group will receive dietary consultation for a standard of care diet as recommended by Canada's Food Guide. Patients in the intervention group will consult with a dietician before starting a 4-week preoperative well-formulated very low carbohydrate KD. All participants will track daily nutritional intake and provide weekly summary reports via an app called Cronometer. The investigators will analyze differences in intraoperative blood loss and OR time, postoperative complications, disease recurrence and mortality rates between the two groups.
Interventions
DIETARY_SUPPLEMENTKetogenic Diet
4-week preoperative well-formulated very low carbohydrate isocaloric diet consisting of 50g net daily carbohydrates and 1.5g/kg protein with the remaining energy needs consisting of primarily mono- and polyunsaturated fats
Sponsors
Anton Skaro
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Caregiver, Outcomes Assessor)
Masking description
The surgeons, surgical team, and data abstractors will be blinded to participant randomization
Intervention model description
preoperative ketogenic diet group vs control standard of care preoperative diet
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients 18 years of age or older undergoing any type of liver resection (e.g. wedge, formal hepatectomy), either open or laparoscopic, for colorectal liver metastases (CRLM) * Patients with evidence of hepatic steatosis on pre-operative imaging (CT or MR) or biopsy. * Ability to use an app based nutritional program to track macronutrient uptake throughout the dietary intervention.
Exclusion criteria
* Patients undergoing liver resection for any other indication * Patients on sodium glucose co-transporter 2 (SGLT-2) inhibitors (these are contraindicated with a ketogenic diet). * Patients without evidence of hepatic steatosis. * Patients with evidence of liver fibrosis or cirrhosis on preoperative bloodwork or imaging. * Patients with alcohol-related hepatic steatosis. * Patients with a known bleeding disorder.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Perioperative blood transfusion | postoperative days 0-7 | receipt (binary) of packed red blood cell (pRBC) units intraoperatively and during the immediate postoperative time period (POD 0 - 7) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Amount of perioperative blood transfusion | postoperative days 0-7 | Number of pRBC units transfused |
| Intraoperative blood loss | Operative period | Intraoperative blood loss: measured by net sponge weight and fluid suctioned minus irrigation fluid |
| Steatosis | Time of primary surgery | Level of steatosis in liver resection specimen |
| Change in steatosis | ~6 weeks | Change in steatosis in liver pre-diet vs day of surgery |
| Operative time | During primary surgery | time from surgery start to surgery stop |
| Postoperative complications | Postoperative days 0-30 | Postoperative complications (measured via the Clavien-Dindo Index) will be assessed within 30 days of the operation. |
| Postoperative length of hospital stay | Postoperative days 0-30 | Postoperative length of hospital stay will be assessed. |
| Postoperative hospital readmission | Postoperative days 0-30 | Hospital readmission will be assessed within 30 days of the operation |
| Postoperative rates of reoperation | Postoperative days 0-30 | Reoperation rates will be assessed within 30 days of the initial surgery. |
| Postoperative liver failure | Postoperative days 0-30 | Liver failure rates will be assessed within 30 days of the initial surgery. |
| Postoperative mortality | Postoperative days 0-30 | Mortality rates will be assessed within 30 days of the initial surgery. |
| Adherence to ketogenic diet | 4 weeks | whether participants adhered to the diet assigned to them |
| Disease recurrence | 0 - 5 years postoperatively | Time to disease recurrence will be assessed up to 5 years postoperatively. |
| Measurement of circulating cell-free tumor DNA | 0 - 5 years postoperatively | Circulating cell-free tumour DNA levels will be measured up to 5 years postoperatively. |
| Cancer-related mortality | 0 - 5 years postoperatively | Cancer-related mortality rates will be assessed up to 5 years postoperatively. |
Countries
Canada
Contacts
CONTACTAnton Skaro, MD PhD
CONTACTCrystal Engelage, PhD
PRINCIPAL_INVESTIGATORAnton Skaro, MD PhD
London Health Sciences Centre/Lawson Health Research Institute
Outcome results
None listed