Clinical Surgical Oncology · Jun 13, 2026
Can GLP-1RA be utilised for pre-operative liver optimisation prior to hepatectomy? A scoping review of MASLD evidence with surgical translation
By Vaitha R, Lakha AS, D’Costa J et al.
Background Hepatectomy remains a high-risk operation, with postoperative morbidity significantly increased by metabolic dysfunction–associated steatotic liver disease (MASLD). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been shown to reduce hepatic fat deposition and inflammation while improving biochemical profiles in MASLD, suggesting potential value for preoperative optimisation. No studies have directly evaluated GLP-1RA in the pre-hepatectomy setting; this scoping review extrapolates from general MASLD populations to inform future trial design. Methods A systematic search of Ovid MEDLINE, Embase, and PubMed identified studies examining GLP-1RAs and liver disease. An expert multidisciplinary panel from the Oxford Liver Cancer Centre of Excellence defined key areas relevant to surgical translation: optimal treatment duration, preferred assessment methods for hepatic fat, oncological safety, and agent selection. Data informing these domains were synthesised descriptively and presented narratively. Results Across 596 studies, GLP-1RAs demonstrated hepatic fat reduction within 6–12 weeks, predominantly assessed by magnetic resonance imaging–proton density fat fraction. Liraglutide and dulaglutide showed favourable efficacy and safety for surgical candidates. Safety considerations included gastrointestinal side effects, sarcopenia risk, and delayed gastric emptying. Conclusion Existing MASLD data support the potential of GLP-1RAs for pre-hepatectomy optimisation. Prospective surgical trials are now required to determine clinical efficacy and safety.