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World Journal of Surgery
Published in: World Journal of Surgery 1/2023

Open Access 30-10-2022 | Liver Surgery | Scientific Review

Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations 2022

Authors: Gaëtan-Romain Joliat, Kosuke Kobayashi, Kiyoshi Hasegawa, John-Edwin Thomson, Robert Padbury, Michael Scott, Raffaele Brustia, Olivier Scatton, Hop S. Tran Cao, Jean-Nicolas Vauthey, Selim Dincler, Pierre-Alain Clavien, Stephen J. Wigmore, Nicolas Demartines, Emmanuel Melloul

Published in: World Journal of Surgery | Issue 1/2023

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Abstract

Background

Enhanced Recovery After Surgery (ERAS) has been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016. The aim of the present article was to update the ERAS guidelines in liver surgery using a modified Delphi method based on a systematic review of the literature.

Methods

A systematic literature review was performed using MEDLINE/PubMed, Embase, and the Cochrane Library. A modified Delphi method including 15 international experts was used. Consensus was judged to be reached when >80% of the experts agreed on the recommended items. Recommendations were based on the Grading of Recommendations, Assessment, Development and Evaluations system.

Results

A total of 7541 manuscripts were screened, and 240 articles were finally included. Twenty-five recommendation items were elaborated. All of them obtained consensus (>80% agreement) after 3 Delphi rounds. Nine items (36%) had a high level of evidence and 16 (64%) a strong recommendation grade. Compared to the first ERAS guidelines published, 3 novel items were introduced: prehabilitation in high-risk patients, preoperative biliary drainage in cholestatic liver, and preoperative smoking and alcohol cessation at least 4 weeks before hepatectomy.

Conclusions

 These guidelines based on the best available evidence allow standardization of the perioperative management of patients undergoing liver surgery. Specific studies on hepatectomy in cirrhotic patients following an ERAS program are still needed.
Appendix
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Metadata
Title
Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations 2022
Authors
Gaëtan-Romain Joliat
Kosuke Kobayashi
Kiyoshi Hasegawa
John-Edwin Thomson
Robert Padbury
Michael Scott
Raffaele Brustia
Olivier Scatton
Hop S. Tran Cao
Jean-Nicolas Vauthey
Selim Dincler
Pierre-Alain Clavien
Stephen J. Wigmore
Nicolas Demartines
Emmanuel Melloul
Publication date
30-10-2022
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 1/2023
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-022-06732-5

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