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Article Dans Une Revue British Journal of Surgery Année : 2023

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

Florian Primavesi
Manuel Maglione
Federica Cipriani
Timm Denecke
  • Fonction : Auteur
Christian Oberkofler
Patrick Starlinger
  • Fonction : Auteur
Bobby Dasari
Jan Heil
  • Fonction : Auteur
Kjetil Søreide
Rafael Diaz-Nieto
  • Fonction : Auteur
Adam Frampton
  • Fonction : Auteur
Dominik Geisel
  • Fonction : Auteur
Mickaël Lesurtel
Damian Mole
Robert Öllinger
  • Fonction : Auteur
Thomas Reiberger
  • Fonction : Auteur
Andreas Schnitzbauer
Christoph Schwarz
  • Fonction : Auteur
Ernesto Sparrelid
  • Fonction : Auteur
Martin Stockmann
  • Fonction : Auteur
Stéphanie Truant
Luca Aldrighetti
Eva Braunwarth
  • Fonction : Auteur
Mathieu D’hondt
  • Fonction : Auteur
Michelle Deoliveira
  • Fonction : Auteur
Joris Erdmann
David Fuks
  • Fonction : Auteur
Thomas Gruenberger
Klaus Kaczirek
  • Fonction : Auteur
Hassan Malik
  • Fonction : Auteur
Dietmar Öfner
Nuh Rahbari
  • Fonction : Auteur
Georg Göbel
  • Fonction : Auteur
Ajith Siriwardena
Stefan Stättner
  • Fonction : Auteur

Résumé

Abstract 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.

Dates et versions

hal-04544062 , version 1 (12-04-2024)

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Citer

Florian Primavesi, Manuel Maglione, Federica Cipriani, Timm Denecke, Christian Oberkofler, et al.. E-AHPBA–ESSO–ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy. British Journal of Surgery, 2023, 110 (10), pp.1331-1347. ⟨10.1093/bjs/znad233⟩. ⟨hal-04544062⟩

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