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The effect of preoperative low-calorie diets on liver resection outcomes.

Liver resection is a cornerstone in the treatment of a wide variety of primary and secondary liver pathologies. Despite improvements in operative techniques and surgical technology over the years, the Achilles heel of liver resection remains intraoperative blood loss (1). The latest Cochrane network meta-analysis examining the myriad of perioperative measures (ranging from cardiopulmonary interventions to intraoperative parenchymal transection and hemostatic techniques) aimed at reducing intraoperative blood loss and blood transfusion requirements during liver surgery concluded that low quality evidence was available at best to support a low central venous pressure and the use of certain hemostatic adjuncts (oxidized cellulose and fibrin sealants) (2).