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The E-AHPBA-ESSO-Innsbruck consensus recommendations on peri- and postoperative management following liver resection

Liver surgery carries a high risk of complications due to the complex interplay of patient-related factors, disease characteristics, and liver function. Expertise is essential for healthcare professionals managing hepatobiliary patients. This European consensus provides evidence-based guidance on se...

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Autori principali: Maier, Eva (Autore) , Stättner, Stefan (Autore) , Carrion-Alvarez, Lucia (Autore) , Di Martino, Marcello (Autore) , Olthof, Pim (Autore) , Primavesi, Florian (Autore) , Sochorova, Dana (Autore) , van Laarhoven, Stijn (Autore) , Balakrishnan, Anita (Autore) , Breitkopf, Robert (Autore) , Buis, Carlijn I (Autore) , Cipriani, Federica (Autore) , Erdmann, Joris (Autore) , Frampton, Adam (Autore) , Fuks, David (Autore) , Gilg, Stefan (Autore) , Gulla, Aiste (Autore) , Lancellotti, Francesco (Autore) , Margreiter, Christian (Autore) , Melloul, Emmanuel (Autore) , Oberkofler, Christian (Autore) , Petritsch, Stefan (Autore) , Raab, Helmut (Autore) , Rahbari, Nuh Nabi (Autore) , Rappold, Daniela (Autore) , Reiberger, Thomas (Autore) , Ruzzenente, Andrea (Autore) , Sallinen, Ville (Autore) , Schaefer, Benedikt (Autore) , Schnitzbauer, Andreas A (Autore) , Serrablo, Alejandro (Autore) , Soreide, Kjetil (Autore) , Sparrelid, Ernesto (Autore) , Starlinger, Patrick (Autore) , Stavrou, Gregor A (Autore) , Tinguely, Pascale (Autore) , Aldrighetti, Luca (Autore) , Dasari, Bobby V M (Autore) , Donadon, Matteo (Autore) , Dopazo, Cristina (Autore) , Gruenberger, Thomas (Autore) , Jonas, Eduard (Autore) , Malik, Hassan (Autore) , Viganó, Luca (Autore) , Siriwardena, Ajith K (Autore) , Maglione, Manuel (Autore)
Natura: Article (Journal)
Lingua:inglese
Pubblicazione: 30 December 2025
In: The British journal of surgery
Year: 2026, Volume: 113, Fascicolo: 1, Pages: 1-25
ISSN:1365-2168
DOI:10.1093/bjs/znaf272
Accesso online:Verlag, kostenfrei, Volltext: https://doi.org/10.1093/bjs/znaf272
Verlag, kostenfrei, Volltext: https://academic.oup.com/bjs/article/113/1/znaf272/8407252?login=true
Testo
Note sull'autore:Eva Maier, Stefan Stättner, Lucia Carrion-Alvarez, Marcello Di Martino, Pim Olthof, Florian Primavesi, Dana Sochorova, Stijn van Laarhoven, Anita Balakrishnan, Robert Breitkopf, Carlijn I Buis, Federica Cipriani, Joris Erdmann, Adam Frampton, David Fuks, Stefan Gilg, Aiste Gulla, Francesco Lancellotti, Christian Margreiter, Emmanuel Melloul, Christian Oberkofler, Stefan Petritsch, Helmut Raab, Nuh N. Rahbari, Daniela Rappold, Thomas Reiberger, Andrea Ruzzenente, Ville Sallinen, Benedikt Schaefer, Andreas A Schnitzbauer, Alejandro Serrablo, Kjetil Soreide, Ernesto Sparrelid, Patrick Starlinger, Gregor A Stavrou, Pascale Tinguely, Luca Aldrighetti, Bobby V.M. Dasari, Matteo Donadon, Cristina Dopazo, Thomas Gruenberger, Eduard Jonas, Hassan Malik, Luca Viganó, Ajith K Siriwardena and Manuel Maglione
Descrizione
Riassunto:Liver surgery carries a high risk of complications due to the complex interplay of patient-related factors, disease characteristics, and liver function. Expertise is essential for healthcare professionals managing hepatobiliary patients. This European consensus provides evidence-based guidance on selected aspects of peri- and postoperative care.A modified Delphi process was used to achieve consensus, with a 70% agreement threshold. The expert panel comprised hepatobiliary surgeons, anaesthetists, hepatologists, a specialist nurse, and a physiotherapist. A systematic literature search was conducted in PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases. Six topics were addressed: thromboprophylaxis; perioperative antibiotics; prehabilitation/nutrition/mobilization; bile leak including bilioenteric anastomosis leaks; post-hepatectomy haemorrhage; and post-hepatectomy liver failure (PHLF). Evidence appraisal and statement development followed Scottish Intercollegiate Guidelines Network methodology. A patient representative reviewed the guideline.Searching the literature yielded 204 included publications from an initial 6514. Thirty-two statements were formulated with a median evidence level of 2. Evidence strength varied by topic with noticeably lower evidence levels in complex surgery settings and less prevalent conditions. In some topics, study heterogeneity and specific inclusion criteria resulted in conditional recommendations, despite high-level evidence. Notably, the weakest evidence was found for perioperative thromboprophylaxis and PHLF management. Strong recommendations were formulated for prehabilitation, early postoperative mobilization, and avoidance of routine drain use. Several evidence gaps warranting multicentre studies were identified.Optimizing peri- and postoperative care after liver resection remains challenging. Standardizing key practices and addressing evidence gaps through collaborative research are vital to improve outcomes.
Descrizione del documento:Gesehen am 07.04.2026
Descrizione fisica:Online Resource
ISSN:1365-2168
DOI:10.1093/bjs/znaf272

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