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RESEARCH PRODUCT

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

Alessandro TropeaMarco BarbaraDanilo TerzoLaura LomaglioFabrizio Di FrancescoDuilio PaganoCalogero RicottaSalvatore GruttadauriaSalvatore GruttadauriaSergio CalamiaDavide Cintorino

subject

Laparoscopic surgeryLiver CirrhosisMalemedicine.medical_specialtyCirrhosisCarcinoma Hepatocellularmedicine.medical_treatmentLiver transplantation03 medical and health sciences0302 clinical medicinePostoperative ComplicationsmedicineHepatectomyHumansERASPostoperative PeriodAgedRetrospective StudiesAnalgesicsbusiness.industryNutritional SupportLiver NeoplasmsRetrospective cohort studyPerioperativehepatocellular carcinomalaparoscopic liver resectionLength of StayMiddle Agedmedicine.diseaseSurgery030220 oncology & carcinogenesisHepatocellular carcinomaoutcome030211 gastroenterology & hepatologySurgeryFemaleLaparoscopyHepatectomybusinessLiver cancerEnhanced Recovery After Surgery

description

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.

yearjournalcountryeditionlanguage
2020-01-01
10.1089/lap.2020.0445http://hdl.handle.net/10447/514822