The E-AHPBA-ESSO-Innsbruck consensus recommendations on peri- and postoperative management following liver resection.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Maier Eva, Stättner Stefan, Carrion-Alvarez Lucia, Di Martino Marcello, Olthof Pim, Primavesi Florian, Sochorova Dana, van Laarhoven Stijn, Balakrishnan Anita, Breitkopf Robert, Buis Carlijn I, Cipriani Federica, Erdmann Joris, Frampton Adam, Fuks David, Gilg Stefan, Gulla Aiste, Lancellotti Francesco, Margreiter Christian, Melloul Emmanuel, Oberkofler Christian, Petritsch Stefan, Raab Helmut, Rahbari Nuh N, Rappold Daniela, Reiberger Thomas, Ruzzenente Andrea, Sallinen Ville, Schaefer Benedikt, Schnitzbauer Andreas A, Serrablo Alejandro, Soreide Kjetil, Sparrelid Ernesto, Starlinger Patrick, Stavrou Gregor A, Tinguely Pascale, Aldrighetti Luca, Dasari Bobby V M, Donadon Matteo, Dopazo Cristina, Gruenberger Thomas, Jonas Eduard, Malik Hassan, Viganó Luca, Siriwardena Ajith K, Maglione Manuel
Аннотация
METHODS: A 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.
RESULTS: Searching 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.
CONCLUSION: Optimizing peri- and postoperative care after liver resection remains challenging. Standardizing key practices and addressing evidence gaps through collaborative research are vital to improve outcomes.