Due to the lack of evidence, the use of immunonutrition in hepatic surgery is not recommended yet. (2C)

Preoperative fasting of 2 h for liquids and 6 h for solids before anesthesia is safe and can be recommended. (1B)

Carbohydrate loading is recommended the evening before liver surgery and 2–4 h before induction of anesthesia. Preoperative carbohydrate loading is safe and improves perioperative insulin resistance, but it is not clear if it is associated with a reduction of length of stay in liver surgery. (2C)

Long-acting anxiolytic drugs should be avoided, particularly in the elderly. Preoperative gabapentinoids and nonsteroidal anti-inflammatory drugs are not recommended. Preoperative acetaminophen should be dose-adjusted according to extent of resection. Preoperative hyoscine patches can be used in patients with high risk for postoperative nausea and vomiting but should be avoided in the elderly. (1B)

Low molecular weight heparin or unfragmented heparin reduces the risk of thromboembolic events and should be routinely started postoperatively unless exceptional circumstances make this unsafe. Intermittent pneumatic compression devices should be used to furtherreduce this risk. (1B)

Steroid administration (methylprednisolone at a dose of 500 mg) is recommended. No recommendation can be formulated on diabetic patients undergoing liver surgery. (2B)

Antibiotic prophylaxis (such as cefazolin) within 60 min before surgical incision is recommended, with no benefit extending it into the postoperative period. In case of complex liver surgery with biliary reconstruction, a targeted antibiotic pre-emptive regimen based on preoperative bile culture may be recommended but its duration is unknown. (2B)

Skin preparation with chlorhexidine-alcoholic solution is associated with a lower rate of surgical site infections, compared to povidoneiodine solution. (1B)

In trained teams and when clinically appropriate, laparoscopic liver resection is recommended since it reduces postoperative length of stay and complication rates. (1B)

For open liver surgery, thoracic epidural analgesia can provide excellent analgesia but has significant disadvantages. In fact, optimal postoperative management is key to avoid hypotension and mobility issues which can be detrimental to rapid recovery. Multimodal analgesia (including potential use of intrathecal opiates) is recommended. (1A)