Effects of a new perioperative enhanced recovery after surgery protocol in hepatectomy for hepatocellular carcinoma
- 11 Downloads
Enhanced recovery after surgery (ERAS) protocols are becoming the standard of care in many surgical procedures, although data on their use following hepatectomy for hepatocellular carcinoma (HCC) are scarce. This study aimed to evaluate the effects of a new ERAS pathway in terms of the patient nutrition status after hepatectomy for HCC.
This is a retrospective analysis of 97 consecutive patients treated with open or laparoscopic hepatectomy for HCC between January 2011 and August 2014. We compared the perioperative outcomes between patients whose treatment incorporated the ERAS pathway and control patients. The nutritional status was evaluated using the controlling nutritional status score.
The length of hospital stay (LOS) after both open and laparoscopic hepatectomy was shorter for the ERAS group than the control group. The days of ambulation and cessation of intravenous infusion were earlier and the postoperative nutrition status was statistically better in the ERAS group than in the control group. A multivariate analysis showed that being in the non-ERAS group was a risk factor of delayed discharge. There were no marked differences in the rate of severe complications between the two groups.
The ERAS pathway seems feasible and safe and results in a faster recovery, reduced LOS, improved nutrition status, and fewer severe complications.
KeywordsEnhanced recovery after surgery Hepatectomy Hepatocellular carcinoma Controlling nutrition status
The authors thank Dr. Go Miyata (Iwate Prefectural Central Hospital) for offering helpful discussion during the writing of the manuscript.
Compliance with ethical standards
Conflict of interest
Atsushi Fujio and the other co-authors have no conflicts of interest to declare in association with this study.
- 10.de Ulibarri JI, Gonzalez-Madrono A, de Villar NG, Gonzalez P, Gonzalez B, Mancha A, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp. 2005;20:38–45.Google Scholar
- 20.Usami M, Miyoshi M, Kanbara Y, Aoyama M, Sakaki H, Shuno K, et al. Effects of perioperative synbiotic treatment on infectious complications, intestinal integrity, and fecal flora and organic acids in hepatic surgery with or without cirrhosis. JPEN J Parenter Enteral Nutr. 2011;35:317–28.CrossRefGoogle Scholar
- 22.Di Sandro S, Bagnardi V, Najjar M, Buscemi V, Lauterio A, De Carlis R, et al. Minor laparoscopic liver resection for hepatocellular carcinoma is safer than minor open resection, especially for less compensated cirrhotic patients: propensity score analysis. Surg Oncol. 2018;27:722–9.CrossRefGoogle Scholar