Cited by 330Enhanced Recovery After SurgeryHemodynamic Monitoring and TherapyNausea and vomiting management

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

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Joliat, Gaëtan‐Romain, Kobayashi, Kosuke, Hasegawa, Kiyoshi, Thomson, John‐Edwin, Padbury, Robert, Scott, Michael, Brustia, Raffaele, Scatton, Olivier +7 more·2023·World Journal of Surgery

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.

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  • The heterogeneity of study designs and glucocorticoid doses applied with moderate overall evidence still result in a weak grade of recommendation in the most recent ERAS® guidelines.

    “To date, the heterogeneity of study designs and glucocorticoid doses applied with moderate overall evidence still result in a weak grade of recommendation in the most recent ERAS® (enhanced recovery after surgery) guidelines [44].”

    From The Role of Perioperative Interleukin-6 Serum Levels on Liver Dysfunction and Infectious Complications After Hepatectomy—A Systematic Review (2025) · cites this paper as [44]

    The Results section on preoperative steroids reports varied doses and assigns the recommendation moderate evidence and a weak grade. The quality-assessment section says inconsistency can affect evidence grading, but the paper does not specifically say that heterogeneity of study designs and doses caused the weak recommendation. No page numbers were available in our copy. (LLM, conf=0.82)

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Authors
Joliat, G., Kobayashi, K., Hasegawa, K., Thomson, J., Padbury, R., Scott, M., Brustia, R., Scatton, O., Tran Cao, H. S., Vauthey, J., Dincler, S., Clavien, P., Wigmore, S. J., Demartines, N., & Melloul, E.
Affiliations
  • Centre Hospitalier Universitaire Vaudois (CH)
  • University of Tokyo Hospital (JP)
  • Flinders Medical Centre (AU)
  • Leonard Davis Institute of Health Economics (US)
  • Centre Hospitalier Universitaire Henri-Mondor (FR)
  • Assistance Publique – Hôpitaux de Paris (FR)
  • Department of Surgical Oncology The University of Texas MD Anderson Cancer Center Houston USA
  • The University of Texas MD Anderson Cancer Center (US)
  • Department of Surgery, Swiss HPB Center University of Zurich Hospital Zurich Switzerland
  • University Hospital Zurich (CH)
  • University of Edinburgh (GB)
Corresponding author
Demartines, Nicolas
Venue
World Journal of Surgery
Publisher
Wiley
Published
2022-10-30
Volume
47
Issue
1
Pages
11-34
ISSN
  • 0364-2313 (ISSN-L)
  • 1432-2323
OpenAlex
W4307650856
Cited by
330
References
4
Citations by year
2026: 94 · 2025: 96 · 2024: 61 · 2023: 49 · 2022: 7 · 2021: 5 · 2020: 7 · 2019: 5 · 2018: 5 · 2017: 1
FWCI
12.65
Type
journal article
Language
en
Open access
Locations
  • World Journal of Surgery (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • SERVAL (Université de Lausanne) (submittedVersion, cc-by)
  • IRIS (submittedVersion, cc-by)
Funders
  • University of Lausanne
  • Université de Lausanne
Topics
  • Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
  • Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
  • Health Sciences › Medicine › Surgery › Nausea and vomiting management
Keywords
enhanced recovery after surgery, liver surgery, perioperative care, hepatectomy, prehabilitation, preoperative biliary drainage, cholestasis, smoking cessation, alcohol cessation, liver cirrhosis, ERAS guidelines
MeSH terms
Enhanced Recovery After Surgery, Preoperative Exercise, Humans, Liver, Teaching Rounds

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