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E-AHPBA–ESSO–ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy
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 ass...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10480040/ https://www.ncbi.nlm.nih.gov/pubmed/37572099 http://dx.doi.org/10.1093/bjs/znad233 |
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author | Primavesi, Florian Maglione, Manuel Cipriani, Federica Denecke, Timm Oberkofler, Christian E Starlinger, Patrick Dasari, Bobby V M Heil, Jan Sgarbura, Olivia Søreide, Kjetil Diaz-Nieto, Rafael Fondevila, Constantino Frampton, Adam E Geisel, Dominik Henninger, Benjamin Hessheimer, Amelia J Lesurtel, Mickaël Mole, Damian Öllinger, Robert Olthof, Pim Reiberger, Thomas Schnitzbauer, Andreas A Schwarz, Christoph Sparrelid, Ernesto Stockmann, Martin Truant, Stéphanie Aldrighetti, Luca Braunwarth, Eva D’Hondt, Mathieu DeOliveira, Michelle L Erdmann, Joris Fuks, David Gruenberger, Thomas Kaczirek, Klaus Malik, Hassan Öfner, Dietmar Rahbari, Nuh N Göbel, Georg Siriwardena, Ajith K Stättner, Stefan |
author_facet | Primavesi, Florian Maglione, Manuel Cipriani, Federica Denecke, Timm Oberkofler, Christian E Starlinger, Patrick Dasari, Bobby V M Heil, Jan Sgarbura, Olivia Søreide, Kjetil Diaz-Nieto, Rafael Fondevila, Constantino Frampton, Adam E Geisel, Dominik Henninger, Benjamin Hessheimer, Amelia J Lesurtel, Mickaël Mole, Damian Öllinger, Robert Olthof, Pim Reiberger, Thomas Schnitzbauer, Andreas A Schwarz, Christoph Sparrelid, Ernesto Stockmann, Martin Truant, Stéphanie Aldrighetti, Luca Braunwarth, Eva D’Hondt, Mathieu DeOliveira, Michelle L Erdmann, Joris Fuks, David Gruenberger, Thomas Kaczirek, Klaus Malik, Hassan Öfner, Dietmar Rahbari, Nuh N Göbel, Georg Siriwardena, Ajith K Stättner, Stefan |
author_sort | Primavesi, Florian |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-10480040 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-104800402023-09-06 E-AHPBA–ESSO–ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy Primavesi, Florian Maglione, Manuel Cipriani, Federica Denecke, Timm Oberkofler, Christian E Starlinger, Patrick Dasari, Bobby V M Heil, Jan Sgarbura, Olivia Søreide, Kjetil Diaz-Nieto, Rafael Fondevila, Constantino Frampton, Adam E Geisel, Dominik Henninger, Benjamin Hessheimer, Amelia J Lesurtel, Mickaël Mole, Damian Öllinger, Robert Olthof, Pim Reiberger, Thomas Schnitzbauer, Andreas A Schwarz, Christoph Sparrelid, Ernesto Stockmann, Martin Truant, Stéphanie Aldrighetti, Luca Braunwarth, Eva D’Hondt, Mathieu DeOliveira, Michelle L Erdmann, Joris Fuks, David Gruenberger, Thomas Kaczirek, Klaus Malik, Hassan Öfner, Dietmar Rahbari, Nuh N Göbel, Georg Siriwardena, Ajith K Stättner, Stefan Br J Surg Guideline 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. Oxford University Press 2023-08-12 /pmc/articles/PMC10480040/ /pubmed/37572099 http://dx.doi.org/10.1093/bjs/znad233 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Guideline Primavesi, Florian Maglione, Manuel Cipriani, Federica Denecke, Timm Oberkofler, Christian E Starlinger, Patrick Dasari, Bobby V M Heil, Jan Sgarbura, Olivia Søreide, Kjetil Diaz-Nieto, Rafael Fondevila, Constantino Frampton, Adam E Geisel, Dominik Henninger, Benjamin Hessheimer, Amelia J Lesurtel, Mickaël Mole, Damian Öllinger, Robert Olthof, Pim Reiberger, Thomas Schnitzbauer, Andreas A Schwarz, Christoph Sparrelid, Ernesto Stockmann, Martin Truant, Stéphanie Aldrighetti, Luca Braunwarth, Eva D’Hondt, Mathieu DeOliveira, Michelle L Erdmann, Joris Fuks, David Gruenberger, Thomas Kaczirek, Klaus Malik, Hassan Öfner, Dietmar Rahbari, Nuh N Göbel, Georg Siriwardena, Ajith K Stättner, Stefan E-AHPBA–ESSO–ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy |
title | E-AHPBA–ESSO–ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy |
title_full | E-AHPBA–ESSO–ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy |
title_fullStr | E-AHPBA–ESSO–ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy |
title_full_unstemmed | E-AHPBA–ESSO–ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy |
title_short | E-AHPBA–ESSO–ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy |
title_sort | e-ahpba–esso–essr innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy |
topic | Guideline |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10480040/ https://www.ncbi.nlm.nih.gov/pubmed/37572099 http://dx.doi.org/10.1093/bjs/znad233 |
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