• Antoine Monsel, Alexandre Sitbon, Charles Roux, Daniel Eyraud, Olivier Scatton, Corinne Vezinet, Marie-Virginie Oré, Jérémy Gallet, Mathilde Wagner, Dominique Thabut, Sarah Boughdad, Florence Renaud, Alessandra Mazzola, Claire Goumard, Manon Allaire, and Liver Institute of la Pitié-Salpêtrière (LIPS)—University Hospital in Paris.
• From the Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP) Sorbonne University, Paris, France (AM, AS, DE, CV, MVO, JG), Sorbonne Université-INSERM UMRS_959, Immunology-Immunopathology-Immunotherapy (I3), 75013 Paris, France (AM), Sorbonne Université, INSERM, Centre de Recherche de Saint-Antoine (CRSA), UMRS-938, 75012, Paris, France (AM, AS, OS, CG), Department of Advanced Interventional Radiology, APHP, Sorbonne University, Hôpital Pitié-Salpétrière, Paris, France (CR), Hepatology and gastrenterology Unit, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP) Sorbonne University, Paris, France (DT, AM, MA), Department of Hepatobiliary and Liver Transplantation Surgery, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France (OS, CG), Department of Radiology (SISU), APHP, Sorbonne University, Laboratoire d'imagerie biomédicale, Hôpital Pitié-Salpétrière, Paris, France (MW, SB), Nuclear Medicine Department, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France (SB), Pathology Department, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France (FR), Genomic Instability, Metabolism, Immunity and Liver Tumorigenesis laboratory, Equipe Labellisée LIGUE 2023, Paris, France (MA), Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Paris, France (MA), Radiotherapy Department, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
• Eur J Anaesthesiol. 2025 Feb 13.

BackgroundThe incidence of hepatocellular carcinoma (HCC) is on the rise worldwide, due to the increasing prevalence of liver diseases associated with metabolic dysfunction and better management of cirrhosis and its complications. The diversification of HCC treatments has recently increased, with the choice of strategy based on HCC characteristics, liver function and comorbidities. The combination of new therapies has transformed the prognosis, with up to 70% survival at 5 years.ObjectiveThe aim of this review was to analyse the most recent data on preoperative evaluation, peri-operative anaesthetic management of liver resection, liver transplantation and other types of procedures, and to highlight the multidisciplinary aspect of such management.Main Findings And DiscussionThe importance of preanaesthetic evaluation will depend largely on the procedure proposed, associated co-morbidities and the stage of liver disease. This assessment should verify stabilisation of all comorbidities, and evaluate the degree of portal hypertension, cirrhosis severity and sarcopenia. Liver resection and liver transplantation for HCC present specific surgical challenges, and minimally invasive techniques improve recovery. Nonsurgical procedures considered as therapeutic (ablation) or standby (regional embolisation) are diverse, and all expose patients to specific intra-anaesthetic complications, sometimes requiring intensive care management. Peri-operative anaesthetic strategies deployed in the management of liver resection or nonsurgical procedures involve specific management of fluids, coagulation, narcosis and analgesia, which can impact on patients' overall, and cancer prognosis. Lastly, new down-staging strategies combining several types of procedure and possibly immunotherapy, also call for collegial reflection on posthepatic transplant immunosuppression, which must remain tailored to each individual patient.Copyright © 2025 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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