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

Gaëtan Romain Joliat, Kosuke Kobayashi, Kiyoshi Hasegawa, John Edwin Thomson, Robert Padbury, Michael Scott, Raffaele Brustia, Olivier Scatton, Hop S. Tran Cao, Jean Nicolas Vauthey, Selim Dincler, Pierre Alain Clavien, Stephen J. Wigmore, Nicolas Demartines, Emmanuel Melloul

Research output: Contribution to journalReview articlepeer-review

25 Citations (Scopus)
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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.

Original languageEnglish
Pages (from-to)11-34
Number of pages24
JournalWorld Journal of Surgery
Issue number1
Early online date30 Oct 2022
Publication statusPublished - Jan 2023
Externally publishedYes


  • Enhanced Recovery After Surgery (ERAS)
  • Liver Surgery


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