Cirrhosis and non-hepatic surgery in 2023 - a precision medicine approach

Sean M Morris, Nadir Abbas, Daniel-Clement Osei-Bordom, Simon P Bach, Dhiraj Tripathi, Neil Rajoriya*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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Abstract

INTRODUCTION: Patients with liver disease and portal hypertension frequently require surgery carrying high morbidity and mortality. Accurately estimating surgical risk remains challenging despite improved medical and surgical management.

AREAS COVERED: This review aims to outline a comprehensive approach to preoperative assessment, appraise methods used to predict surgical risk, and provide an up-to-date overview of outcomes for patients with cirrhosis undergoing non-hepatic surgery.

EXPERT OPINION: Robust preoperative, individually tailored, and precise risk assessment can reduce peri- and postoperative complications in patients with cirrhosis. Established prognostic scores aid stratification, providing an estimation of postoperative mortality, albeit with limitations. VOCAL-Penn Risk Score may provide greater precision than established liver severity scores. Amelioration of portal hypertension in advance of surgery may be considered, with prospective data demonstrating hepatic venous pressure gradient as a promising surrogate marker of postoperative outcomes. Morbidity and mortality vary between types of surgery with further studies required in patients with more advanced liver disease. Patient-specific considerations and practicing precision medicine may allow for improved postoperative outcomes.

Original languageEnglish
Pages (from-to)155-173
Number of pages19
JournalExpert review of gastroenterology & hepatology
Volume17
Issue number2
Early online date3 Jan 2023
DOIs
Publication statusPublished - 13 Feb 2023

Keywords

  • Humans
  • Prospective Studies
  • Precision Medicine
  • Liver Cirrhosis/surgery
  • Fibrosis
  • Hypertension, Portal/etiology

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