TY - JOUR
T1 - E-AHPBA-ESSO-ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy
AU - Primavesi, Florian
AU - Maglione, Manuel
AU - Cipriani, Federica
AU - Denecke, Timm
AU - Oberkofler, Christian E.
AU - Starlinger, Patrick
AU - Dasari, Bobby V. M.
AU - Heil, Jan
AU - Sgarbura, Olivia
AU - Søreide, Kjetil
AU - Diaz-Nieto, Rafael
AU - Fondevila, Constantino
AU - Frampton, Adam E.
AU - Geisel, Dominik
AU - Henninger, Benjamin
AU - Hessheimer, Amelia J.
AU - Lesurtel, Mickaël
AU - Mole, Damian
AU - Öllinger, Robert
AU - Olthof, Pim
AU - Reiberger, Thomas
AU - Schnitzbauer, Andreas A.
AU - Schwarz, Christoph
AU - Sparrelid, Ernesto
AU - Stockmann, Martin
AU - Truant, Stéphanie
AU - Aldrighetti, Luca
AU - Braunwarth, Eva
AU - D'Hondt, Mathieu
AU - DeOliveira, Michelle L.
AU - Erdmann, Joris
AU - Fuks, David
AU - Gruenberger, Thomas
AU - Kaczirek, Klaus
AU - Malik, Hassan
AU - Öfner, Dietmar
AU - Rahbari, Nuh N.
AU - Göbel, Georg
AU - Siriwardena, Ajith K.
AU - Stättner, Stefan
N1 - Publisher Copyright: © 2023 The Author(s).
PY - 2023/10
Y1 - 2023/10
N2 - BACKGROUND: Posthepatectomy liver failure (PHLF) contributes significantly to morbidity and mortality after liver surgery. Standardized assessment of preoperative liver function is crucial to identify patients at risk. These European consensus guidelines provide guidance for preoperative patient assessment. METHODS: A modified Delphi approach was used to achieve consensus. The expert panel consisted of hepatobiliary surgeons, radiologists, nuclear medicine specialists, and hepatologists. The guideline process was supervised by a methodologist and reviewed by a patient representative. A systematic literature search was performed in PubMed/MEDLINE, the Cochrane library, and the WHO International Clinical Trials Registry. Evidence assessment and statement development followed Scottish Intercollegiate Guidelines Network methodology. RESULTS: Based on 271 publications covering 4 key areas, 21 statements (at least 85 per cent agreement) were produced (median level of evidence 2- to 2+). Only a few systematic reviews (2++) and one RCT (1+) were identified. Preoperative liver function assessment should be considered before complex resections, and in patients with suspected or known underlying liver disease, or chemotherapy-associated or drug-induced liver injury. Clinical assessment and blood-based scores reflecting liver function or portal hypertension (for example albumin/bilirubin, platelet count) aid in identifying risk of PHLF. Volumetry of the future liver remnant represents the foundation for assessment, and can be combined with indocyanine green clearance or LiMAx® according to local expertise and availability. Functional MRI and liver scintigraphy are alternatives, combining FLR volume and function in one examination. CONCLUSION: These guidelines reflect established methods to assess preoperative liver function and PHLF risk, and have uncovered evidence gaps of interest for future research.
AB - BACKGROUND: Posthepatectomy liver failure (PHLF) contributes significantly to morbidity and mortality after liver surgery. Standardized assessment of preoperative liver function is crucial to identify patients at risk. These European consensus guidelines provide guidance for preoperative patient assessment. METHODS: A modified Delphi approach was used to achieve consensus. The expert panel consisted of hepatobiliary surgeons, radiologists, nuclear medicine specialists, and hepatologists. The guideline process was supervised by a methodologist and reviewed by a patient representative. A systematic literature search was performed in PubMed/MEDLINE, the Cochrane library, and the WHO International Clinical Trials Registry. Evidence assessment and statement development followed Scottish Intercollegiate Guidelines Network methodology. RESULTS: Based on 271 publications covering 4 key areas, 21 statements (at least 85 per cent agreement) were produced (median level of evidence 2- to 2+). Only a few systematic reviews (2++) and one RCT (1+) were identified. Preoperative liver function assessment should be considered before complex resections, and in patients with suspected or known underlying liver disease, or chemotherapy-associated or drug-induced liver injury. Clinical assessment and blood-based scores reflecting liver function or portal hypertension (for example albumin/bilirubin, platelet count) aid in identifying risk of PHLF. Volumetry of the future liver remnant represents the foundation for assessment, and can be combined with indocyanine green clearance or LiMAx® according to local expertise and availability. Functional MRI and liver scintigraphy are alternatives, combining FLR volume and function in one examination. CONCLUSION: These guidelines reflect established methods to assess preoperative liver function and PHLF risk, and have uncovered evidence gaps of interest for future research.
UR - http://www.scopus.com/inward/record.url?scp=85169847364&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/bjs/znad233
DO - https://doi.org/10.1093/bjs/znad233
M3 - Article
C2 - 37572099
SN - 0007-1323
VL - 110
SP - 1331
EP - 1347
JO - The British journal of surgery
JF - The British journal of surgery
IS - 10
ER -