Perioperative Medicine in Oncologic Hepato-Pancreato-Biliary Surgery – An Evidence- Based Narrative Review of Perioperative Concepts

Optimizing perioperative care in oncologic hepato-pancreato-biliary (HPB) surgery is critical to improving surgical outcomes and long-term prognosis. This narrative review provides a comprehensive synthesis of current concepts in perioperative medicine, including risk stratification, prehabilitation, enhanced recovery after surgery (ERAS) pathways, neoadjuvant therapy, and the management of procedure-specific complications in pancreatic and hepato- biliary surgery.
In pancreatic cancer surgery, advances in neoadjuvant strategies for borderline resectable disease, individualized antibiotic prophylaxis, and structured ERAS pathways have significantly influenced clinical outcomes. Similarly, in hepatobiliary surgery, neo-adjuvant concepts are evolving for hepatocellular and cholangiocarcinoma, while prehabilitation and risk-based ERAS implemen-tation are gaining importance. Special attention is given to complications such as postoperative pancreatic fistula, bile leakage, portal vein thrombosis, small-for-size syndrome, and liver failure.
Drainage strategies are discussed in light of recent guideline-based recommendations, emphasizing the importance of avoiding prophylactic drainage in uncomplicated liver and pancreatic resections. Novel concepts such as staged hepatectomy with ALPPS, combined vein embolization, and minimally invasive liver surgery, including robotic approaches, expand the surgical toolbox but demand strict patient selection and high expertise.
Taken together, perioperative care in HPB oncology is transitioning toward a multimodal, individualized approach. Future directions include the integration of precision medicine in surgical oncology and perioperative care into standard pathways to further reduce complication-related failure-to-rescue and improve oncological outcomes.

Keywords: HPB surgery, Neoadjuvant therapy, Oncologic surgery, Perioperative medicine, Prehabilitation, Preoperative optimization