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

Liver surgery carries a high risk of complications due to the interplay of patient-related factors, disease characteristics and liver function. This European consensus provides evidence-based guidance on selected aspects of perioperative care.

A modified Delphi process was used to achieve consensus, with a 70 % agreement threshold. The expert panel comprised hepatobiliary surgeons, anaesthetists, hepatologists, a nurse and physiotherapist. Systematic literature search was conducted in PubMed/Medline, EMBASE, Web of Science, and Cochrane databases. Evidence appraisal and statement development followed Scottish Intercollegiate Guidelines Network methodology.

Six topics were addressed: (i) thromboprophylaxis, (ii) antibiotics, (iii) prehabilitation-nutrition-mobilisation, (iv) bile leaks, including bilio-enteric anastomosis, (v) post-hepatectomy haemorrhage, (vi) post-hepatectomy liver failure (PHLF). Screening yielded 204 included publications (initial 6514) and thirty-two statements were formulated (median evidence-level:2). Evidence strength varied by topic with lower evidence-levels in complex surgery settings and subcohorts. Study heterogeneity and specific inclusion criteria resulted in some topics in conditional recommendations despite high-level evidence. Weakest evidence was found for thromboprophylaxis and PHLF managment. Strong recommendations were formulated for prehabilitation, mobilisation, and avoidance of routine drainage. Several evidence gaps warranting multicentre studies were identified.

Optimising perioperative care after hepatectomy remains challenging. Standardising key practices and addressing evidence gaps through collaborative research are vital to improve outcomes.