Ann Surg Treat Res.  2020 May;98(5):224-234. 10.4174/astr.2020.98.5.224.

Enhanced recovery after surgery strategy for cirrhosis patients undergoing hepatectomy: experience in a single research center

• Zheng Y
• Wang L
• Wu F
• Rong W
• Liu Y
• Zhang K
• Wu J

• KMID: 2500823
• DOI: http://doi.org/10.4174/astr.2020.98.5.224

Abstract

Purpose
To evaluate the safety and effectiveness of an enhanced recovery after surgery (ERAS) programme after curative liver resection in cirrhotic hepatocellular carcinoma (HCC) patients.
Methods
One hundred sixty-two patients were enrolled in the study; 80 patients whose data were collected prospectively were assigned to the ERAS group, and 82 patients whose data were collected retrospectively were assigned to the control group. Preoperative clinicopathologic factors, surgical factors, and postoperative outcomes of the 2 groups were compared. Logistic regression was applied to explore potential predictors of hospital stay and morbidity.
Results
The postoperative hospital stay, postoperative complication rate, and recovery of liver function on postoperative day 5 seemed to be better in the ERAS group. The composition of complications was different in the 2 groups; pleural effusion and postoperative ascites were more common in the control group, and indocyanine green retention at 15 minutes, operation time, preoperative alanine aminotransferase, and number of liver segmentectomies were associated with postoperative complications rather than ERAS intervention.
Conclusion
The ERAS programme is safe and effective for HCC patients with chronic liver disease undergoing hepatectomy, but it seems that surgical factors, such as operation type, have a greater impact on morbidity than other factors. Operative characteristics such as the method of blood loss control and the volume of liver resection should be augmented into ERAS protocol of hepatectomy.

Keyword

Enhanced recovery after surgery; Hepatectomy; Hepatitis; Hepatocellular carcinoma; Liver cirrhosis

Figure

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  Fig. 1 Forest plot of multivariate analysis of the risk factors for postoperative complications. OR, odds ratio; CI, confidence interval; ICG15, indocyanine green retention at 15 minutes.

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  Fig. 2 Postoperative biochemical parameters of the 2 groups. Mean ± standard deviation of ALT/AST/TBIL/ALB/PTa/CRP in the ERAS and control groups on POD 1/3/5. Squares represent the control group and circles represent the ERAS group. P-values from repeated measurement analysis of variance. TBIL, total bilirubin; ALB, albumin; PTa, prothrombin activity; ERAS, enhanced recovery after surgery; POD, postoperative day. *P < 0.05, statistically significant differences.

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