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

다국어 초록 (Multilingual 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.

목차 (Table of Contents)

• INTRODUCTION
• METHODS
• RESULTS
• DISCUSSION
• REFERENCES

참고문헌 (Reference)

1 Rossi G, "Two-day hospital stay after laparoscopic colorectal surgery under an enhanced recovery after surgery(ERAS)pathway" 37 : 2483-2489, 2013

2 Nishikawa H, "The relationship between controlling nutritional(CONUT)score and clinical markers among adults with hepatitis C virus related liver cirrhosis" 10 : 1185-, 2018

3 Fearon KC, "The nutritional management of surgical pat ients : enhanced recovery after surgery" 62 : 807-811, 2003

4 김성진, "The comparison of oncologic and clinical outcomes of laparoscopic liver resection for hepatocellular carcinoma" 대한외과학회 86 (86): 61-67, 2014

5 Clavien PA, "The Clavien-Dindo classification of surgical complications : five-year experience" 250 : 187-196, 2009

6 Wang L, "Regional ischemic preconditioning has clinical value in cirrhotic HCC through MAPK pathways" 23 : 1767-1777, 2019

7 Yoon YI, "Pure laparoscopic versus open right hepatectomy for hepatocellular carcinoma in patients with cirrhosis : a propensity score matched analysis" 265 : 856-863, 2017

8 Harimoto N, "Prognostic significance of preoperative controlling nutritional status(CONUT)score in patients undergoing hepatic resection for hepatocellular carcinoma : a multiinstitutional study" 25 : 3316-3323, 2018

9 Carli F, "Physiologic considerations of enhanced recovery after surgery(ERAS)programs : implications of the stress response" 62 : 110-119, 2015

10 Kamiyama T, "Perioperative management of hepatic resection toward zero mortality and morbidity : analysis of 793 consecutive cases in a single institution" 211 : 443-449, 2010

11 Page AJ, "Perioperat ive management of hepatic resection" 3 : 19-27, 2012

12 Day RW, "Patientreported outcomes accurately measure the value of an enhanced recovery program in liver surgery" 221 : 1023-1030, 2015

13 Koretz RL, "Nutritional support for liver disease" 2012 : CD 008344-, 2012

14 Masuda T, "Nutrition support and infections associated with hepatic resection and liver transplantation in patients with chronic liver disease" 37 : 318-326, 2013

15 Wilmore DW, "Management of patients in fast track surgery" 322 : 473-476, 2001

16 Wu CC, "Liver resection for hepatocellular carcinoma in patients with cirrhosis" 92 : 348-355, 2005

17 Lu X, "Improvement of nutritional support strategies after surgery for benign liver tumor through nutritional risk screening : a prospective, randomized, controlled, single-blind clinical study" 2 : 14-21, 2013

18 Sahara K, "Impact of liver cirrhosis on perioperative outcomes among elderly patients undergoing hepatectomy : the effect of minimally invasive surgery" 23 : 2346-2353, 2019

19 Wilmore DW, "From Cuthbertson to fasttrack surgery : 70 years of progress in reducing stress in surgical patients" 236 : 643-648, 2002

20 Ni TG, "Enhanced recovery after surgery programs in patients undergoing hepatectomy : a meta-analysis" 21 : 9209-9216, 2015

21 Sasaki K, "Effect of background liver cirrhosis on outcomes of hepatectomy for hepatocellular carcinoma" 152 : e165059-, 2017

22 Li L, "Early postoperative controlling nutritional status(CONUT)score is associated with complication III-V after hepatectomy in hepatocellular carcinoma : a retrospective cohort study of 1, 334patients" 8 : 13406-, 2018

23 van Zelm R, "Development of a model care pathway for adults undergoing colorectal cancer surgery : evidence-based key interventions and indicators" 24 : 232-239, 2018

24 de Araujo Lamino D, "Cancer patients caregivers comfort" 48 : 278-284, 2014

25 Wu JX, "Application of selective and timely regional hepatic vascular occlusion for resection of large centrally located liver tumors : report of 133 cases" 34 : 850-854, 2012

26 Takamoto T, "Applicability of enhanced recovery program for advanced liver surgery" 38 : 2676-2682, 2014

27 Yu W, "Adjuvant radiotherapy in centrally located hepatocellular carcinomas after hepatectomy with narrow margin(<1cm) : a prospective randomized study" 218 : 381-392, 2014

28 Fuster J, "Abdominal drainage after liver resection for hepatocellular carcinoma in cirrhotic patients : a randomized controlled study" 51 : 536-540, 2004

29 Heimbach JK, "AASLD guidelines for the treatment of hepatocellular carcinoma" 67 : 358-380, 2018

30 Mannan R, "A comparative evaluation of scoring systems for assessing necroinflammatory activity and fibrosis in liver biopsies of patients with chronic viral hepatitis" 8 : FC08-FC12, 2014