Enhanced Recovery After Surgery in Patients With Hepatocellular Carcinoma Undergoing Laparoscopic Hepatectomy

Objective: To compare the effectiveness and safety of enhanced recovery after surgery (ERAS) in patients with hepatocellular carcinoma (HCC) undergoing laparoscopic hepatectomy.Methods: From September 2016 to June 2019, 282 patients were enrolled, and ERAS was implemented since March 2018. All indic...

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Autores principales: Jiamin Zhou, Xigan He, Miao Wang, Yiming Zhao, Ning Zhang, Longrong Wang, Anrong Mao, Lu Wang
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Publicado: Frontiers Media S.A. 2021
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spelling oai:doaj.org-article:415921ae33e24e45a5ed503d255477262021-11-22T04:43:18ZEnhanced Recovery After Surgery in Patients With Hepatocellular Carcinoma Undergoing Laparoscopic Hepatectomy2296-875X10.3389/fsurg.2021.764887https://doaj.org/article/415921ae33e24e45a5ed503d255477262021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fsurg.2021.764887/fullhttps://doaj.org/toc/2296-875XObjective: To compare the effectiveness and safety of enhanced recovery after surgery (ERAS) in patients with hepatocellular carcinoma (HCC) undergoing laparoscopic hepatectomy.Methods: From September 2016 to June 2019, 282 patients were enrolled, and ERAS was implemented since March 2018. All indicators related to surgery, liver function, and postoperative outcomes were included in the analysis. Propensity score matching (PSM) identified 174 patients for further comparison.Results: After PSM, the clinicopathological baselines were well-matched. The group showed significantly less intraoperative blood loss (100.00 [100.00–200.00] vs. 200.00 [100.00–300.00] ml, P = 0.001), fewer days before abdominal drainage tube removal (4.00 [3.00–4.00] days vs. 4.00 [3.00–5.00] days, P = 0.023), shorter hospital stay after surgery (6.00 [5.00–6.00] days vs. 6.00 [6.00–7.00] days, P < 0.001), and reduced postoperative morbidity (18.39 vs. 34.48%, P = 0.026). The proportion of patients with a pain score ≥ 4 was significantly lower in the ERAS group within the first 2 days after surgery (1.15 vs. 13.79% and 8.05 vs. 26.44%, P = 0.002 and P = 0.001, respectively). Pringle maneuver was performed more frequently in the ERAS group (70.11 vs. 18.39%, P < 0.001), and a significantly higher postoperative alanine aminotransferase level was also observed (183.40 [122.85–253.70] vs. 136.20 [82.93–263.40] U/l, P = 0.026). The 2-year recurrence-free survival was similar between the two groups (72 vs. 71%, P = 0.946).Conclusions: ERAS programs are feasible and safe and do not influence mid-term recurrence in HCC patients undergoing laparoscopic hepatectomy.Jiamin ZhouJiamin ZhouXigan HeXigan HeMiao WangMiao WangYiming ZhaoYiming ZhaoNing ZhangNing ZhangLongrong WangLongrong WangAnrong MaoAnrong MaoLu WangLu WangFrontiers Media S.A.articleenhanced recovery after surgeryhepatocellular carcinomahepatectomylaparoscopyliver functionSurgeryRD1-811ENFrontiers in Surgery, Vol 8 (2021)
institution DOAJ
collection DOAJ
language EN
topic enhanced recovery after surgery
hepatocellular carcinoma
hepatectomy
laparoscopy
liver function
Surgery
RD1-811
spellingShingle enhanced recovery after surgery
hepatocellular carcinoma
hepatectomy
laparoscopy
liver function
Surgery
RD1-811
Jiamin Zhou
Jiamin Zhou
Xigan He
Xigan He
Miao Wang
Miao Wang
Yiming Zhao
Yiming Zhao
Ning Zhang
Ning Zhang
Longrong Wang
Longrong Wang
Anrong Mao
Anrong Mao
Lu Wang
Lu Wang
Enhanced Recovery After Surgery in Patients With Hepatocellular Carcinoma Undergoing Laparoscopic Hepatectomy
description Objective: To compare the effectiveness and safety of enhanced recovery after surgery (ERAS) in patients with hepatocellular carcinoma (HCC) undergoing laparoscopic hepatectomy.Methods: From September 2016 to June 2019, 282 patients were enrolled, and ERAS was implemented since March 2018. All indicators related to surgery, liver function, and postoperative outcomes were included in the analysis. Propensity score matching (PSM) identified 174 patients for further comparison.Results: After PSM, the clinicopathological baselines were well-matched. The group showed significantly less intraoperative blood loss (100.00 [100.00–200.00] vs. 200.00 [100.00–300.00] ml, P = 0.001), fewer days before abdominal drainage tube removal (4.00 [3.00–4.00] days vs. 4.00 [3.00–5.00] days, P = 0.023), shorter hospital stay after surgery (6.00 [5.00–6.00] days vs. 6.00 [6.00–7.00] days, P < 0.001), and reduced postoperative morbidity (18.39 vs. 34.48%, P = 0.026). The proportion of patients with a pain score ≥ 4 was significantly lower in the ERAS group within the first 2 days after surgery (1.15 vs. 13.79% and 8.05 vs. 26.44%, P = 0.002 and P = 0.001, respectively). Pringle maneuver was performed more frequently in the ERAS group (70.11 vs. 18.39%, P < 0.001), and a significantly higher postoperative alanine aminotransferase level was also observed (183.40 [122.85–253.70] vs. 136.20 [82.93–263.40] U/l, P = 0.026). The 2-year recurrence-free survival was similar between the two groups (72 vs. 71%, P = 0.946).Conclusions: ERAS programs are feasible and safe and do not influence mid-term recurrence in HCC patients undergoing laparoscopic hepatectomy.
format article
author Jiamin Zhou
Jiamin Zhou
Xigan He
Xigan He
Miao Wang
Miao Wang
Yiming Zhao
Yiming Zhao
Ning Zhang
Ning Zhang
Longrong Wang
Longrong Wang
Anrong Mao
Anrong Mao
Lu Wang
Lu Wang
author_facet Jiamin Zhou
Jiamin Zhou
Xigan He
Xigan He
Miao Wang
Miao Wang
Yiming Zhao
Yiming Zhao
Ning Zhang
Ning Zhang
Longrong Wang
Longrong Wang
Anrong Mao
Anrong Mao
Lu Wang
Lu Wang
author_sort Jiamin Zhou
title Enhanced Recovery After Surgery in Patients With Hepatocellular Carcinoma Undergoing Laparoscopic Hepatectomy
title_short Enhanced Recovery After Surgery in Patients With Hepatocellular Carcinoma Undergoing Laparoscopic Hepatectomy
title_full Enhanced Recovery After Surgery in Patients With Hepatocellular Carcinoma Undergoing Laparoscopic Hepatectomy
title_fullStr Enhanced Recovery After Surgery in Patients With Hepatocellular Carcinoma Undergoing Laparoscopic Hepatectomy
title_full_unstemmed Enhanced Recovery After Surgery in Patients With Hepatocellular Carcinoma Undergoing Laparoscopic Hepatectomy
title_sort enhanced recovery after surgery in patients with hepatocellular carcinoma undergoing laparoscopic hepatectomy
publisher Frontiers Media S.A.
publishDate 2021
url https://doaj.org/article/415921ae33e24e45a5ed503d25547726
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