Enhanced recovery after surgery program in open and laparoscopic liver resection

Abstract

Background: Enhanced recovery after surgery (ERAS) has been developed in liver surgery. The program is recognized in reducing postoperative length of hospital stay and patients' stress response to surgery. The aim of this study is to evaluate its efficacy and feasibility in Hong Kong. Methods: This is a prospective feasibility study carried out in a tertiary academic hospital in Hong Kong. A multidisciplinary ERAS protocol had been implemented to both open and laparoscopic liver resection. The clinical outcomes of patients underwent liver resection with ERAS peri-operative program were compared with those received conventional peri-operative program in the same period. Propensity score matching method was used to minimize background differences. Results: From Sept 2015 to Jul 2016, a total of 20 patients underwent liver resection were recruited to ERAS program. Their clinical outcomes were compared with another 20 patients received hepatectomy under conventional perioperative program after propensity score matching. ERAS program was associated with a significantly shorter length of hospital stay (p =0.041) without an increase in complication rate in patients received open liver resection. There was no significance in hospital stay in the laparoscopic group. No patient required readmission in this cohort. Conclusion: ERAS perioperative program for liver resection is safe and feasible. It significantly shortened the hospital stay in open liver resection but not in laparoscopic liver resection.