Eric Levesque, Emmanuel Weiss, Frederic Aubrun, Karim Boudjema, Isaure Breteau, Audrey De Jong, Marie-Charlotte Delignette, Antoine Dewitte, Alexandre Elbaz, Philippe Guerci, Kevin Hakkakian, Charlotte Maulat, Jean-Claude Merle, Clément Monet, Antoine Monsel, Emmanuel Pardo, Aymeric Restoux, Stephanie Roullet, Romain Rozier, Faouzi Saliba, Ugo Schiff, Stylianos Tzedakis, Aurélien Bonnal, Maxime Nguyen
Strong expert agreement was achieved regarding recommendations aimed at optimizing perioperative management in patients undergoing liver resection.
OBJECTIVE: The French Society of Anesthesia and Intensive Care (SFAR), the French Society for the Study of the Liver (AFEF), and the Association for Hepato-Biliary-Pancreatic Surgery and Liver Transplantation (ACHBPT) jointly developed guidelines for the perioperative management of liver resection surgery.
DESIGN: A multidisciplinary panel of French experts from the SFAR, the AFEF, and the ACHBPT was convened. All potential conflicts of interest were officially declared before initiation of the recommendation development process, which was conducted independently of any industry funding. The authors used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology to assess the quality of evidence in the literature.
METHODS: Three areas were defined: (1) preoperative assessment; (2) optimization of intraoperative management; and (3) optimization of postoperative management. For each domain, the objective of the recommendations was to address a series of questions formulated by experts according to the PICO model ("Population, Intervention, Comparison, Outcome"). Based on these questions, an extensive bibliographic search covering the period from 2004 to 2024 was conducted using predefined keywords in accordance with PRISMA recommendations. Data quality was analysed using the GRADE method. Recommendations were formulated according to the GRADE method and subsequently submitted to all experts for voting using the GRADE grid method.
RESULTS: The experts' synthesis and application of the GRADE methodology resulted in 40 recommendations addressing 14 questions. After two rounds of voting and several revisions, strong agreement was achieved for all 40 recommendations. Among these recommendations, 7 were supported by a high level of evidence (GRADE 1), 23 by a low level of evidence (GRADE 2), and 10 corresponded to expert opinions (EO). Finally, no recommendation could be formulated for four questions. (ABS).
CONCLUSION: Strong expert agreement was achieved regarding recommendations aimed at optimizing perioperative management in patients undergoing liver resection.