Application of High-dose Insulin Therapy to Improve Liver Function and Regeneration

Application of High-Dose Insulin Therapy Using a Hyperinsulinemic Normoglycemic Clamp to Improve Liver Function and Regeneration

The primary objective of this interventional study is determine if the future liver remnant can be optimized by improving liver function pre-operatively in patients who are scheduled for major hepatectomy. The main questions it aims to answer are:

1. Does high-dose insulin therapy improve liver function in the pre-operative setting?
2. What is the effect of high-dose insulin therapy on liver function and liver regeneration after a liver venous deprivation (LVD) procedure?
3. What is the relationship between volume hypertrophy and function in the regenerating liver? Participants will receive a 6-hour infusion of insulin and dextrose to maintain a hyperinsulinemic-normoglycemic state in the weeks prior to planned liver surgery to assess its effect on liver function measured by 99m-Tc-Mebrofenin hepatobiliary scintigraphy.

Inclusion Criteria:

• Age > 18 years old
• Candidate for major liver resection
• Resectable colorectal liver metastasis

Exclusion Criteria:

• Inability to give consent
• Type 1 diabetes mellitus
• Uncontrolled blood glucose levels (fasting level > 10 mmol/L)
• Unresectable colorectal liver metastasis
• Extrahepatic metastatic disease that is unresectable