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

Florian Primavesi, Manuel Maglione, Federica Cipriani, Timm Denecke, Christian E. Oberkofler, Patrick Starlinger, Bobby V.M. Dasari, Jan Heil, Olivia Sgarbura, Kjetil Søreide, Rafael Diaz-Nieto, Constantino Fondevila, Adam E. Frampton, Dominik Geisel, Benjamin Henninger, Amelia J. Hessheimer, Mickaël Lesurtel, Damian Mole, Robert Öllinger, Pim OlthofThomas Reiberger, Andreas A. Schnitzbauer, Christoph Schwarz, Ernesto Sparrelid, Martin Stockmann, Stéphanie Truant, Luca Aldrighetti, Eva Braunwarth, Mathieu D'Hondt, Michelle L. DeOliveira, Joris Erdmann, David Fuks, Thomas Gruenberger, Klaus Kaczirek, Hassan Malik, Dietmar Öfner, Nuh N. Rahbari, Georg Göbel, Ajith K. Siriwardena, Stefan Stättner*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

14 Citations (Scopus)
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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. 


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. 


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. 


These guidelines reflect established methods to assess preoperative liver function and PHLF risk, and have uncovered evidence gaps of interest for future research.

Original languageEnglish
Pages (from-to)1331-1347
Number of pages17
JournalThe British journal of surgery
Issue number10
Publication statusPublished - Oct 2023

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