E-AHPBA-ESSO-ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy
Open accessAbstract
Background: 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. Methods: 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. Results: 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. Conclusion: These guidelines reflect established methods to assess preoperative liver function and PHLF risk, and have uncovered evidence gaps of interest for future research.
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Post-hepatectomy liver failure remains a challenging complication in patients undergoing liver resection and represents the major cause of mortality.
“Post-hepatectomy liver failure (PHLF) remains a challenging complication in patients undergoing liver resection and represents the major cause of mortality [5,6,7].”
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 [7]
The Introduction describes PHLF as a frequent cause of major morbidity after extended liver resection and a major determinant of postoperative death. It does not establish that PHLF is the single major cause of mortality, as the citing sentence implies. (LLM, conf=0.86)
Experimental — accuracy not yet measuredMost publications are underpowered to assess CR-PHLF with event rates of 5-15%, with commonly less than 50 patients included per study.
“With commonly less than 50 patients included per study, most publications are underpowered to assess CR-PHLF with event rates of 5–15% according to the literature [5,7,13,38,39].”
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 [7]
The Patient selection section reports a PHLF incidence of 8–12%, which falls within the claimed 5–15% range, but does not specify clinically relevant PHLF. The Discussion says most retrieved publications had low-to-medium evidence; it does not say that most studies enrolled fewer than 50 patients or were underpowered to assess CR-PHLF. Page numbers were not available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredPostoperative liver function mainly determines the overall course and subsequent morbidity after major hepatectomy.
“Especially in major hepatectomies, the postoperative liver function mainly determines the overall course and subsequent morbidity [7,13,35].”
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 [7]
The Introduction (page unavailable) describes posthepatectomy liver failure as one of the most frequent causes of major morbidity after extended resections and a major determinant of postoperative death. This supports the importance of postoperative liver function, but does not establish that it mainly determines the overall postoperative course. (LLM, conf=0.82)
Experimental — accuracy not yet measured
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Cholangiocarcinoma 2026: status quo, unmet needs and priorities
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Self-citationPrecision surgery for hepatocellular carcinoma
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The assessment of impaired liver function and prognosis in hepatocellular carcinoma
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Technological Advances in Pre-Operative Planning
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- Authors
- Primavesi, F., Maglione, M., Cipriani, F., Denecke, T., Oberkofler, C. E., Starlinger, P., Dasari, B. V. M., Heil, J., Sgarbura, O., Søreide, K., Diaz-Nieto, R., Fondevila, C., Frampton, A. E., Geisel, D., Henninger, B., Hessheimer, A. J., Lesurtel, M., Mole, D., Öllinger, R., Olthof, P., Reiberger, T., Schnitzbauer, A. A., Schwarz, C., Sparrelid, E., Stockmann, M., Truant, S., Aldrighetti, L., Braunwarth, E., D’Hondt, M., DeOliveira, M. L., Erdmann, J., Fuks, D., Gruenberger, T., Kaczirek, K., Malik, H., Öfner, D., Rahbari, N. N., Göbel, G., Siriwardena, A. K., & Stättner, S.
- Affiliations
- Innsbruck Medical University (AT)
- IRCCS Ospedale San Raffaele (IT)
- University Hospital Leipzig (DE)
- Klinik Hirslanden (CH)
- Mayo Clinic (US)
- University of Birmingham (GB)
- Goethe University Frankfurt (DE)
- Inserm (FR)
- Stavanger University Hospital (NO)
- Liver Surgery Unit, Liverpool University Hospitals NHS Foundation Trust , Liverpool , UK
- Hospital Universitario La Paz (ES)
- University of Surrey (GB)
- Humboldt-Universität zu Berlin (DE)
- Université Paris Cité (FR)
- University of Edinburgh (GB)
- Charité – Universitätsmedizin Berlin (DE)
- Erasmus MC Cancer Institute (NL)
- Medical University of Vienna (AT)
- Karolinska University Hospital (SE)
- Paul Gerhardt Diakonie (DE)
- Université de Lille (FR)
- AZ Groeninge (BE)
- University Hospital Zurich (CH)
- Amsterdam University Medical Centers (NL)
- Hôpital Cochin (FR)
- Sigmund Freud Privatuniversität Wien (AT)
- Liverpool University Hospitals NHS Foundation Trust (GB)
- Heidelberg University (DE)
- Manchester Royal Infirmary (GB)
- Corresponding author
- Stättner, Stefan
- ORCID
- Primavesi, Florian
- Maglione, Manuel
- Cipriani, Federica
- Denecke, Timm
- Oberkofler, Christian E
- Starlinger, Patrick
- Dasari, Bobby V M
- Heil, Jan
- Sgarbura, Olivia
- Søreide, Kjetil
- Fondevila, Constantino
- Frampton, Adam E
- Geisel, Dominik
- Henninger, Benjamin
- Hessheimer, Amelia J
- Lesurtel, Mickaël
- Mole, Damian
- Öllinger, Robert
- Olthof, Pim
- Reiberger, Thomas
- Schnitzbauer, Andreas A
- Schwarz, Christoph
- Sparrelid, Ernesto
- Stockmann, Martin
- Truant, Stéphanie
- Aldrighetti, Luca
- Braunwarth, Eva
- D’Hondt, Mathieu
- Erdmann, Joris
- Fuks, David
- Gruenberger, Thomas
- Kaczirek, Klaus
- Malik, Hassan
- Öfner, Dietmar
- Rahbari, Nuh N
- Göbel, Georg
- Siriwardena, Ajith K
- Stättner, Stefan
- Venue
- British Journal of Surgery
- Publisher
- Oxford University Press (OUP)
- Published
- 2023-08-12
- Volume
- 110
- Issue
- 10
- Pages
- 1331-1347
- ISSN
- 0007-1323 (ISSN-L)
- 1365-2168
- PMC
- PMC10480040
- OpenAlex
- W4385774018
- Cited by
- 97
- References
- 142
- Citations by year
- 2026: 22 · 2025: 41 · 2024: 29 · 2023: 5
- FWCI
- 16.40
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- British journal of surgery (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, cc-by-nc)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by-nc)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion, cc-by-nc)
- HAL (submittedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Funders
- Medical Research Council (MR/P008887/1)
- Topics
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- preoperative liver function assessment, hepatectomy, post-hepatectomy liver failure, indocyanine green clearance, Limax, functional MRI, liver scintigraphy, portal hypertension, platelet count, drug-induced liver injury, chemotherapy-induced liver injury, risk stratification
- MeSH terms
- Hepatectomy, Humans, Indocyanine Green, Liver, Liver Neoplasms, Postoperative Complications, Retrospective Studies, Liver Failure
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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