ERAS in minimally invasive hepatectomy

Fung, A.; Chong, Charing C.N.; Lai, Paul B.S.

doi:10.14701/ahbps.2020.24.2.119

Cited by 9 publications

(6 citation statements)

References 67 publications

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“…Sixty-nine patients (78%) were treated with nonanatomic resections. Laparoscopic approach was initially chosen for 56 patients; however, in 14 cases, due to difficulties in reaching the tumor lesions, or to previous surgery 17 and HCCs located in unfavorable segments, 15 conversion to open surgery was necessary.…”

Section: Resultsmentioning

confidence: 99%

ERAS Protocol for Perioperative Care of Patients Treated with Laparoscopic Nonanatomic Liver Resection for Hepatocellular Carcinoma: The ISMETT Experience

Pagano

Ricotta

Barbàra

et al. 2020

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Background: Liver resection (LR) remains the best therapeutic option for patients with early-stage hepatocellular carcinoma (HCC) with preserved hepatic function and who are not eligible for liver transplantation. After its inception, the enhanced recovery after surgery (ERAS) protocol was widely used for treating patients with liver cancer, although there are still no clear indications for improving upon it in both open and laparoscopic surgery.Objective: This study aims to describe our institute's experience in the application of the ERAS protocol in a cohort of HCC patients, and to explore possible factors that could have an impact on postoperative outcomes. Materials and Methods: We retrospectively analyzed our experience with LR performed from September 2017 to January 2020 in patients treated with ERAS protocol, focusing on describing impact on postoperative nutrition, analgesic requirements, and length of hospitalization. Demographics, operative factors, and postoperative complications of patients were reviewed. Results: During the study period, 89 HCC patients were eligible for LR, and 75% of patients presented with liver cirrhosis. The most prevalent among etiologic factors was hepatitis C virus infection (53 patients out of 89, 60%), followed by nonalcoholic steatohepatitis (18 patients, 20%). The median age was 70 years. Liver cirrhosis did not have an impact on postoperative course of patients. Patients who underwent laparoscopic surgery and nonanatomic LR experienced low complication rates, shorter length of stay, and shorter time of intravenous analgesic requirements.Conclusions: Continual refinement with ERAS protocol for treating HCC patients based on perioperative counseling and surgical decision-making is crucial to guarantee low complication rates, and reduce patient morbidity and time for recovery.

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Section: Resultsmentioning

confidence: 99%

ERAS Protocol for Perioperative Care of Patients Treated with Laparoscopic Nonanatomic Liver Resection for Hepatocellular Carcinoma: The ISMETT Experience

Pagano

Ricotta

Barbàra

et al. 2020

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“… 15 Studies have shown that ERAS applied during the perioperative period of patients with hepatectomy for liver cancer was safe and effective. 16 , 17 But there have been few studies about the effect of ERAS on the long-term prognosis of patients who underwent hepatectomy. To our knowledge, this study is the first to date, evaluating the effect of enhanced recovery on long-term outcomes after hepatic resection by using propensity score matching.…”

Section: Discussionmentioning

confidence: 99%

Impact of Enhanced Recovery After Surgery on Long-Term Outcomes and Postoperative Recovery in Patients Undergoing Hepatectomy: A Retrospective Cohort Study

Zhang¹,

Zhang

2021

CMAR

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Background: The aim of this study was to evaluate the effects of implementation of the enhanced recovery after surgery (ERAS) program on postoperative recovery and the longterm prognosis in patients who underwent hepatectomy. Methods: This retrospective study enrolled patients who underwent hepatectomy from January 2015 to December 2018 in Huadong Hospital Affiliated to Fudan University. Since June 2016, a 24-point ERAS protocol has been implemented for patients who underwent hepatic resection. The primary outcomes were overall survival (OS) and disease-free survival (DFS). The secondary outcomes included length of stay (LOS), and incidence of postoperative complications. Results: A total of 1143 patients were enrolled in this study. After propensity score matching (PSM), there was no significant difference in patients' demographic characteristics. The DFS at 1., 3 years in ERAS group was higher than in non-ERAS group (96.3% vs 88.9% for 1 year, P=0.012; 58.9% vs 46.7% for 3 years, P=0.007). The OS at 1, 3 years in ERAS group was higher than in non-ERAS group (93.1% vs 89.3% for 1 year, P=0.041; 68.7% vs 61.2% for 3 years, P=0.035). In addition, the patients in ERAS group had lower incidences of postoperative hemorrhage, bile leak, and postoperative deep vein thrombosis/pulmonary embolism (DVT/PE), decreased 30-day readmission rate and total readmission rate, and shorter LOS. Conclusion: ERAS program could be safely applied to patients who underwent hepatectomy thereby improving their recovery and prolonging OS and DFS.

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“…Patients with underlying liver disease have increased risk of perioperative morbidity and benefit from an anesthesia team experienced in the management of coagulopathy, ascites, hyperbilirubinemia, and encephalopathy 52 . The use of enhanced recovery protocols for liver and pancreas surgery may provide a set of best practices for perioperative management and should be considered to standardize care in these complex patients 53,54 …”

Section: How To Build An Mis Hpb Program?mentioning

confidence: 99%

Safe implementation of a minimally invasive hepatopancreatobiliary program, a narrative review and institutional experience

Labadie,

Melstrom,

Lewis

2023

Journal of Surgical Oncology

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Laparoscopic and robotic‐assisted approaches to hepatopancreatobiliary (HPB) operations have expanded worldwide. As surgeons and medical centers contemplate initiating and expanding minimally invasive surgical (MIS) programs for complex HPB surgical operations, there are many factors to consider. This review highlights the key components of developing an MIS HPB program and shares our recent institutional experience with the adoption and expansion of an MIS approach to pancreaticoduodenectomy.

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ERAS in minimally invasive hepatectomy

Cited by 9 publications

References 67 publications

ERAS Protocol for Perioperative Care of Patients Treated with Laparoscopic Nonanatomic Liver Resection for Hepatocellular Carcinoma: The ISMETT Experience

ERAS Protocol for Perioperative Care of Patients Treated with Laparoscopic Nonanatomic Liver Resection for Hepatocellular Carcinoma: The ISMETT Experience

Impact of Enhanced Recovery After Surgery on Long-Term Outcomes and Postoperative Recovery in Patients Undergoing Hepatectomy: A Retrospective Cohort Study

Safe implementation of a minimally invasive hepatopancreatobiliary program, a narrative review and institutional experience

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