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E-AHPBA-ESSO-ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy.

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Preoperative liver function assessment is vital for identifying patients at risk of posthepatectomy liver failure (PHLF). These guidelines offer standardized methods for assessing liver function and PHLF risk before surgery.

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Area of Science:

  • Hepatology
  • Surgical Oncology
  • Radiology

Background:

  • Posthepatectomy liver failure (PHLF) is a major cause of morbidity and mortality following liver surgery.
  • Standardized preoperative liver function assessment is critical for identifying at-risk patients.
  • These European consensus guidelines provide a framework for preoperative patient evaluation.

Purpose of the Study:

  • To establish European consensus guidelines for preoperative assessment of liver function.
  • To identify patients at risk of posthepatectomy liver failure (PHLF).
  • To guide clinicians in managing patients undergoing liver surgery.

Main Methods:

  • A modified Delphi approach involving a multidisciplinary expert panel.
  • Systematic literature search across major databases (PubMed/MEDLINE, Cochrane).
  • Evidence assessment and statement development following Scottish Intercollegiate Guidelines Network (SIGN) methodology.

Main Results:

  • 21 consensus statements developed based on 271 publications, with ≥85% agreement.
  • Clinical assessment and blood-based scores (e.g., albumin/bilirubin, platelet count) help identify PHLF risk.
  • Volumetry of the future liver remnant (FLR), combined with functional tests (e.g., indocyanine green, LiMAx®, fMRI, scintigraphy), forms the basis of assessment.

Conclusions:

  • The guidelines present established methods for preoperative liver function and PHLF risk assessment.
  • These guidelines highlight areas requiring future research to address evidence gaps.
  • Implementation of these guidelines can improve patient outcomes after liver surgery.