Evidence map›Paper›PMID 41467576›Full record

GuidelineThe British journal of surgery2025

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

Eva Maier, Stefan Stättner, Lucia Carrion-Alvarez, Marcello Di Martino, Pim Olthof, Florian Primavesi, Dana Sochorova, Stijn van Laarhoven, Anita Balakrishnan, Robert Breitkopf and 36 more

Abstract readPractice GuidelineConsensus Statement
In one paragraph

Guideline in The British journal of surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. International journal of molecular sciences · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

46 authors.

Eva MaierDepartment of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria.ORCID 0000-0002-5210-7358
Stefan StättnerDepartment of Visceral and General Surgery, Hepatobiliary Centre, Kepler University Hospital GmbH, Linz, Austria.
Lucia Carrion-AlvarezHPB Unit, General Surgery Department, Fuenlabrada University Hospital, Madrid, Spain.
Marcello Di MartinoDepartment of Health Sciences, Università del Piemonte Orientale, Novara, Italy.ORCID 0000-0001-6510-7210
Pim OlthofDepartment of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.ORCID 0000-0002-1691-1808
Florian PrimavesiDepartment of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria.
Dana SochorovaDepartment of Surgery, Tomas Bata Hospital, Zlin, Czech Republic.
Stijn van LaarhovenDepartment of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.ORCID 0000-0002-3579-2533
Anita BalakrishnanCambridge Hepatopancreatobiliary Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Robert BreitkopfDepartment of Anaesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
Carlijn I BuisDepartment of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Centre Groningen, Groningen, The Netherlands.
Federica CiprianiHepatobiliary Surgery Division, San Raffaele Scientific Institute, Milan, Italy.ORCID 0000-0002-8651-5982
Joris ErdmannDepartment of Surgery, Amsterdam UMC, Amsterdam, The Netherlands.ORCID 0000-0001-8233-1505
Adam FramptonHPB Surgical Unit, Royal Surrey NHS Foundation Trust, Guildford, UK.
David FuksDepartment of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Stefan GilgDepartment of Clinical Science, Intervention and Technology, Division of Surgery and Oncology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Aiste GullaFaculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.
Francesco LancellottiRegional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK.ORCID 0000-0002-1830-127X
Christian MargreiterDepartment of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria.
Emmanuel MelloulDepartment of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Christian OberkoflerVivévis AG-Visceral, Tumour and Robotic Surgery, Clinic Hirslanden Zurich, Zurich, Switzerland.ORCID 0000-0002-7330-3876
Stefan PetritschDepartment for General, Visceral and Vascular Surgery, Salzkammergut Klinikum Vöcklabruck, Vöcklabruck, Austria.
Helmut RaabDepartment of Anaesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
Nuh N RahbariDepartment of Surgery, Medical Faculty Mannheim, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.
Daniela RappoldDepartment for General, Visceral and Vascular Surgery, Salzkammergut Klinikum Vöcklabruck, Vöcklabruck, Austria.
Thomas ReibergerDivision of Gastroenterology and Hepatology, Department of Medicine III and CD-Lab for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria.
Andrea RuzzenenteGeneral and Hepatobiliary Surgery, Department of Surgery, Dentistry, Gynaecology and Paediatrics University of Verona, GB Rossi Hospital, Verona, Italy.
Ville SallinenDepartment of Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.ORCID 0000-0001-5394-4169
Benedikt SchaeferDepartment of Gastroenterology, Medical University Innsbruck, Innsbruck, Austria.
Andreas A SchnitzbauerKnappschaft Clinics University Hospital Bochum, Ruhr-University Bochum, Bochum, Germany.
Alejandro SerrabloHPB Unit, Miguel Servet University Hospital, Zaragoza, Spain.
Kjetil SoreideDepartment of Gastrointestinal Surgery, HPB Unit, Stavanger University Hospital, Stavanger, Norway.ORCID 0000-0001-7594-4354
Ernesto SparrelidDepartment of Clinical Science, Intervention and Technology, Division of Surgery and Oncology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Patrick StarlingerDepartment of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, Minnesota, USA.ORCID 0000-0002-4666-5337
Gregor A StavrouDepartment of General, Visceral and Thoracic Surgery, Surgical Oncology, Klinikum Saarbruecken, Saarbruecken, Germany.
Pascale TinguelyDepartment of Visceral and Transplantation Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Luca AldrighettiHepatobiliary Surgery Division, San Raffaele Scientific Institute, Milan, Italy.ORCID 0000-0001-7729-2468
Bobby V M DasariDepartment of HBP and Liver Transplantation Surgery, University of Birmingham, Birmingham, UK.
Matteo DonadonDepartment of Health Sciences, Università del Piemonte Orientale, Novara, Italy.ORCID 0000-0003-0296-7648
Cristina DopazoDepartment of General Surgery, Division of HPB Surgery and Transplants, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autónoma de Barcelona Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.ORCID 0000-0001-6274-5911
Thomas GruenbergerDepartment of Surgery, Clinic Favoriten, HPB Centre, Health Network Vienna and Sigmund Freud Private University, Vienna, Austria.ORCID 0000-0002-2671-0540
Eduard JonasSurgical Gastroenterology Unit, Division of General Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Hassan MalikLiver Surgery Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
Luca ViganóDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.ORCID 0000-0002-4108-4832
Ajith K SiriwardenaRegional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK.
Manuel MaglioneDepartment of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria.ORCID 0000-0003-1479-6129

Funding

BJS Foundation
6 · The paper itself

Abstract

backgroundLiver surgery carries a high risk of complications due to the complex interplay of patient-related factors, disease characteristics, and liver function. Expertise is essential for healthcare professionals managing hepatobiliary patients. This European consensus provides evidence-based guidance on selected aspects of peri- and postoperative care.

methodsA modified Delphi process was used to achieve consensus, with a 70% agreement threshold. The expert panel comprised hepatobiliary surgeons, anaesthetists, hepatologists, a specialist nurse, and a physiotherapist. A systematic literature search was conducted in PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases. Six topics were addressed: thromboprophylaxis; perioperative antibiotics; prehabilitation/nutrition/mobilization; bile leak including bilioenteric anastomosis leaks; post-hepatectomy haemorrhage; and post-hepatectomy liver failure (PHLF). Evidence appraisal and statement development followed Scottish Intercollegiate Guidelines Network methodology. A patient representative reviewed the guideline.

resultsSearching the literature yielded 204 included publications from an initial 6514. Thirty-two statements were formulated with a median evidence level of 2. Evidence strength varied by topic with noticeably lower evidence levels in complex surgery settings and less prevalent conditions. In some topics, study heterogeneity and specific inclusion criteria resulted in conditional recommendations, despite high-level evidence. Notably, the weakest evidence was found for perioperative thromboprophylaxis and PHLF management. Strong recommendations were formulated for prehabilitation, early postoperative mobilization, and avoidance of routine drain use. Several evidence gaps warranting multicentre studies were identified.

conclusionOptimizing peri- and postoperative care after liver resection remains challenging. Standardizing key practices and addressing evidence gaps through collaborative research are vital to improve outcomes.

Indexed as

HepatectomyPerioperative CarePostoperative CarePostoperative ComplicationsDelphi TechniqueHumans

Identifiers

PMID41467576
PMCPMC12750329

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.