European medical experts created new guidelines to help doctors take better care of patients before and after liver surgery. They reviewed hundreds of scientific studies and agreed on best practices for preventing blood clots, using antibiotics, helping patients recover faster, and managing complications. The guidelines cover six important areas of care that doctors should focus on. While some areas have strong evidence supporting specific approaches, others need more research. These recommendations aim to help hospitals standardize their care and improve patient outcomes after this complex surgery.

The Quick Take

  • What they studied: What are the best practices for taking care of patients before and after liver removal surgery?
  • Who participated: This wasn’t a study of patients. Instead, European liver surgeons, anesthesiologists, liver specialists, nurses, and physical therapists reviewed 204 scientific studies to create guidelines.
  • Key finding: Experts agreed on 32 best practices for liver surgery care. Strong evidence supports early mobilization (getting patients moving), prehabilitation (preparing before surgery), and avoiding routine drain tubes. However, some areas like blood clot prevention and managing liver failure need more research.
  • What it means for you: If you’re having liver surgery, ask your hospital if they follow these guidelines. Hospitals that use these evidence-based practices may have better outcomes. However, your doctor may adjust recommendations based on your specific situation.

The Research Details

This was a consensus guideline project, not a traditional research study. European experts in liver surgery, anesthesia, and related fields worked together to review the scientific literature on liver surgery care. They used a structured process called the modified Delphi method, where experts vote on recommendations until at least 70% agree. The team searched four major medical databases and found 204 relevant studies from an initial pool of 6,514 papers. They organized their findings into six main topic areas and evaluated the quality of evidence for each recommendation using established guidelines from Scotland’s medical system.

Liver surgery is complicated and risky because the liver is complex and patients often have serious diseases. Different hospitals may use different approaches, which can lead to varying outcomes. By creating consensus guidelines based on the best available evidence, experts can help standardize care across Europe and improve patient safety and recovery.

This guideline has several strengths: it involved multiple types of experts (surgeons, anesthesiologists, specialists), reviewed hundreds of studies systematically, and included a patient representative. However, the evidence quality varies by topic—some recommendations are based on strong research, while others are based on weaker evidence. The authors were honest about gaps where more research is needed, particularly for blood clot prevention and managing liver failure after surgery.

What the Results Show

The expert panel created 32 recommendations across six areas. For prehabilitation (preparing before surgery), early mobilization (getting patients moving soon after surgery), and nutrition, the evidence was strong and recommendations were clear. Experts strongly recommended against routinely using drain tubes after surgery, as evidence shows they don’t improve outcomes and may cause problems. For preventing blood clots, the guidelines suggest using blood thinners but acknowledge the evidence isn’t as strong as desired. Managing bile leaks (when digestive fluid leaks after surgery) had moderate evidence supporting specific surgical techniques. Post-hepatectomy liver failure (when the remaining liver doesn’t work well after surgery) and managing bleeding after surgery had the weakest evidence, meaning doctors still need better research to guide these decisions.

The review identified several important gaps in current research. Complex liver surgeries and rare conditions have less scientific evidence available. The experts noted that many studies had different methods and patient populations, making it hard to combine results. They emphasized that while these guidelines provide a framework, individual patient factors must always be considered. The guideline also highlighted the importance of specialized expertise—liver surgery should be done at experienced centers with multidisciplinary teams.

These guidelines build on and update previous recommendations for liver surgery care. They incorporate newer evidence on early mobilization and prehabilitation, which have become increasingly important in modern surgery. The strong recommendation against routine drains represents a shift from older practices. The guidelines align with international trends toward faster recovery protocols while maintaining safety.

This guideline has several limitations to understand. It’s based on published research, which may not capture all clinical experience. Some recommendations are conditional rather than strong because studies used different methods or included different patient types. The evidence for some critical areas (blood clot prevention, liver failure management) is weaker than ideal. Guidelines can’t account for every individual patient’s unique situation. Finally, implementing these guidelines requires resources and training that not all hospitals may have available.

The Bottom Line

If you’re having liver surgery: (1) Ask your hospital if they use prehabilitation programs—prepare your body before surgery through exercise and nutrition (Strong evidence). (2) Expect early mobilization after surgery—getting up and moving soon aids recovery (Strong evidence). (3) Ask whether drain tubes will be used—they’re often unnecessary (Strong evidence). (4) Ensure you receive appropriate antibiotics and blood clot prevention (Moderate to strong evidence). (5) Discuss blood thinner use with your doctor based on your individual risk (Moderate evidence). (6) Ask about liver failure monitoring if you have limited liver function (Weak evidence, needs more research).

These guidelines are most relevant for: patients scheduled for liver surgery, their families, surgeons and hospitals performing liver surgery, and anesthesiologists. People with liver disease, cancer, or cirrhosis considering surgery should discuss these recommendations with their doctors. These guidelines may be less directly applicable to emergency liver surgery or very rare situations, where individual judgment is essential.

Benefits vary by recommendation. Prehabilitation benefits appear within weeks before surgery. Early mobilization benefits appear within days after surgery (reduced complications, faster discharge). Blood clot prevention works continuously throughout recovery. Full recovery from liver surgery typically takes 4-12 weeks, depending on the extent of surgery and individual factors.

Want to Apply This Research?

  • Track daily mobilization minutes (walking, light activity) starting immediately after surgery, aiming for gradual increases. Log any complications (fever, pain, unusual symptoms) and share with your medical team.
  • If preparing for liver surgery: (1) Start a prehabilitation program 4-6 weeks before surgery—use the app to track exercise minutes and nutrition goals. (2) After surgery, use the app to log daily walking and activity levels, aiming to increase gradually. (3) Monitor and report any warning signs (fever, bleeding, bile-colored drainage) immediately.
  • Pre-surgery: track exercise, nutrition, and weight weekly. Post-surgery: log daily activity level, pain scores, and any complications. Share data with your surgical team at follow-up appointments. Continue monitoring for 8-12 weeks post-surgery or as directed by your doctor.

These guidelines are recommendations for healthcare professionals, not personal medical advice. Liver surgery is complex and individual circumstances vary significantly. Always consult with your surgical team about your specific situation, as they may recommend different approaches based on your health status, type of liver disease, and other factors. Never make decisions about liver surgery or postoperative care without discussing them with your doctors. This information is educational and should not replace professional medical judgment.