Application of enhanced recovery after surgery in liver resection during perioperative period_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

REN Qiuping ,  LUO Yanli , XIAO Fengming

Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;

Corresponding?author：

LUO Yanli, Email: luoyl6@126.com

Keywords：

enhanced recovery after surgery; liver resection; complications; perioperative period; meta-analysis

DOI：

10.7507/1007-9424.201610032

Video：

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Objective To systematically evaluate effects of enhanced recovery after surgery (ERAS) programme on clinical outcomes of liver resection during perioperative period. Methods The randomized controlled trials (RCTs) of comparing ERAS programme with traditional care programme in patients underwent liver resection were searched by Wanfang, VIP, CNKI, PubMed, Embase, and Cochrane Library databases from inception to January 2016. The quality of the included RCT was assessed independently according to the Cochrane handbook–version 5.1.0 by two reviewers. Meta-analysis was conducted for the eligible RCTs by using RevMan 5.3.0. Results Seven RCTs containing 844 patients were included in this meta-analysis. There were 35 cases of benign tumor, 809 cases of malignant tumor. The ERAS programmes were performed in 415 patients, while the traditional care programmes were performed in 429 patients. Compared with the traditional care programme, the overall complications rate and the Dindo-Clavien grade Ⅰ complications rate were significantly lower〔OR=0.59, 95%CI (0.41, 0.87),P=0.007;OR=0.45, 95%CI (0.27, 0.76),P=0.002〕, the hospital stay and the first anal exhaust time were significantly shorter〔WMD=–2.66, 95%CI (–3.64, –1.69),P<0.000 01;WMD=–20.25, 95%CI (–32.08, –8.42),P=0.000 8〕 in the ERAS programme, but there was no statistically significant difference of the Dindo-Clavien grade Ⅱ–Ⅳ complications rate between these two groups〔OR=0.93, 95%CI (0.53, 1.63),P=0.80〕. Conclusions ERAS is a safe and effective programme in liver resection during perioperative period. Future studies should define active elements to optimize postoperative outcomes for liver resection.

Citation： REN Qiuping, LUO Yanli, XIAO Fengming. Application of enhanced recovery after surgery in liver resection during perioperative period. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(5): 599-605. doi: 10.7507/1007-9424.201610032 Copy

1.	?Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
2.	Simpson JC, Moonesinghe SR, Grocott MP,et al. Enhanced recovery from surgery in the UK: an audit of the enhanced recovery partnership programme 2009–2012. Br J Anaesth, 2015, 115(4): 560-568.
3.	Varadhan KK, Neal KR, Dejong CH,et al. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr, 2010, 29(4): 434-440.
4.	Sarin A, Litonius ES, Naidu R,et al. Successful implementation of an enhanced recovery after surgery program shortens length of stay and improves postoperative pain, and bowel and bladder function after colorectal surgery. BMC Anesthesiol, 2016, 16(1): 55.
5.	Greco M, Capretti G, Beretta L,et al. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg, 2014, 38(6): 1531-1541.
6.	Gatenby PA, Shaw C, Hine C,et al. Retrospective cohort study of an enhanced recovery programme in oesophageal and gastric cancer surgery. Ann R Coll Surg Engl, 2015, 97(7): 502-507.
7.	Kim JW, Kim WS, Cheong JH,et al. Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer: a randomized clinical trial. World J Surg, 2012, 36(12): 2879-2887.
8.	Mungroop TH, Veelo DP, Busch OR,et al. Continuous wound infiltration or epidural analgesia for pain prevention after hepato-pancreato-biliary surgery within an enhanced recovery program (POP-UP trial): study protocol for a randomized controlled trial. Trials, 2015, 16: 562.
9.	Dejong CH, van Dam RM. Enhanced recovery programs in liver surgery. World J Surg, 2014, 38(10): 2683-2684.
10.	Muehling B, Schelzig H, Steffen P,et al. A prospective randomized trial comparing traditional and fast-track patient care in elective open infrarenal aneurysm repair. World J Surg, 2009, 33(3): 577-585.
11.	Dokmak S, Ftériche FS, Borscheid R,et al. 2 012 liver resections in the 21st century: we are far from zero mortality. HPB (Oxford), 2013, 15(11): 908-915.
12.	Dunne DF, Yip VS, Jones RP,et al. Enhanced recovery in the resection of colorectal liver metastases. J Surg Oncol, 2014, 110(2): 197-202.
13.	Higgins JPT, Green S. Cochrance Handbook for Systematic Reviews of Interventions 5.1.0. The Cochrane Collaboration, 2011.
14.	J?rgensen L, Paludan-Müller AS2, Laursen DR,et al. Evaluation of the Cochrane tool for assessing risk of bias in randomized clinical trials: overview of published comments and analysis of user practice in Cochrane and non-Cochrane reviews. Syst Rev, 2016, 5: 80.
15.	池閩輝, 曾永毅, 劉景豐. 快速康復外科在肝癌肝切除圍手術期的應用研究. 中國腫瘤臨床, 2012, 39(23): 1939-1942.
16.	黃海, 張洪昌, 莫世發, 等. 快速康復外科在腹腔鏡下精準肝切除患者中的應用. 中國內鏡雜志, 2013, 19(6): 603-606.
17.	Lu H, Fan Y, Zhang F,et al. Fast-track surgery improves postoperative outcomes after hepatectomy. Hepatogastroen terology, 2014, 61(129): 168-172.
18.	Jones C, Kelliher L, Dickinson M,et al. Randomized clinical trial on enhanced recoveryversus standard care following open liver resection. Br J Surg, 2013, 100(8): 1015-1024.
19.	Ni CY, Yang Y, Chang YQ,et al. Fast-track surgery improves postoperative recovery in patients undergoing partial hepatectomy for primary liver cancer: A prospective randomized controlled trial. Eur J Surg Oncol, 2013, 39(6): 542-547.
20.	張傳國, 王慶寶, 張廣東, 等. 加速康復外科在肝葉切除術中的應用. 中國實用期刊, 2011, 38(15): 33-36.
21.	樊獻軍, 譚黃業, 肖詠梅, 等. 快速康復外科理念在肝癌圍手術期處理中的應用. 中國普通外科雜志, 2011, 20(7): 684-686.
22.	Higgins JP, Altman DG, G?tzsche PC,et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
23.	Kehlet H. Enhanced Recovery After Surgery (ERAS): good for now, but what about the future? Can J Anaesth, 2015, 62(2): 99-104.
24.	Lemanu DP, Singh PP, Berridge K,et al. Randomized clinical trial of enhanced recovery versus standard care after laparoscopic sleeve gastrectomy. Br J Surg, 2013, 100(4): 482-489.
25.	Stone AB, Grant MC, Pio Roda C,et al. Implementation costs of an enhanced recovery after surgery program in the United States: A financial model and sensitivity analysis based on experiences at a Quaternary Academic Medical Center. J Am Coll Surg, 2016, 222(3): 219-225.
26.	Gustafsson UO, Scott MJ, Schwenk W,et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS^?) Society recommendations.Clin Nutr, 2012, 31(6): 783-800.
27.	Lassen K, Coolsen MM, Slim K,et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS^?) Society recommendations. World J Surg, 2013, 37(2): 240-258.
28.	Mortensen K, Nilsson M, Slim K,et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS^?) Society recommendations. Br J Surg, 2014, 101(10): 1209-1229.
29.	徐瑜杰, 王震, 陳俊強. 快速康復外科在胃癌根治術中應用的系統評價. 中國普外基礎與臨床雜志, 2015, 22(4): 423-433.
30.	Melloul E, Hübner M, Scott M,et al. Guidelines for perioperative care for liver surgery: enhanced recovery after surgery (ERAS) society recommendations.World J Surg, 2016, 40(10): 2425-2440.
31.	Coolsen MM, Wong-Lun-Hing EM, van Dam RM,et al. A systematic review of outcomes in patients undergoing liver surgery in an enhanced recovery after surgery pathways. HPB (Oxford), 2013, 15(4): 245-251.
32.	Hughes MJ, McNally S, Wigmore SJ. Enhanced recovery following liver surgery: a systematic review and meta-analysis. HPB (Oxford), 2014, 16(8): 699-706.
33.	Song W, Wang K, Zhang RJ,et al. The enhanced recovery after surgery (ERAS) program in liver surgery: a meta-analysis of randomized controlled trials. Springerplus, 2016, 5: 207.
34.	Resanovic A, Zdravkovic D, Resanovic V,et al. Comparison of functional recovery is crucial for implementing ERAS. World J Surg, 2017, 41(1): 320-321.

1. ?Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
2. Simpson JC, Moonesinghe SR, Grocott MP,et al. Enhanced recovery from surgery in the UK: an audit of the enhanced recovery partnership programme 2009–2012. Br J Anaesth, 2015, 115(4): 560-568.
3. Varadhan KK, Neal KR, Dejong CH,et al. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr, 2010, 29(4): 434-440.
4. Sarin A, Litonius ES, Naidu R,et al. Successful implementation of an enhanced recovery after surgery program shortens length of stay and improves postoperative pain, and bowel and bladder function after colorectal surgery. BMC Anesthesiol, 2016, 16(1): 55.
5. Greco M, Capretti G, Beretta L,et al. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg, 2014, 38(6): 1531-1541.
6. Gatenby PA, Shaw C, Hine C,et al. Retrospective cohort study of an enhanced recovery programme in oesophageal and gastric cancer surgery. Ann R Coll Surg Engl, 2015, 97(7): 502-507.
7. Kim JW, Kim WS, Cheong JH,et al. Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer: a randomized clinical trial. World J Surg, 2012, 36(12): 2879-2887.
8. Mungroop TH, Veelo DP, Busch OR,et al. Continuous wound infiltration or epidural analgesia for pain prevention after hepato-pancreato-biliary surgery within an enhanced recovery program (POP-UP trial): study protocol for a randomized controlled trial. Trials, 2015, 16: 562.
9. Dejong CH, van Dam RM. Enhanced recovery programs in liver surgery. World J Surg, 2014, 38(10): 2683-2684.
10. Muehling B, Schelzig H, Steffen P,et al. A prospective randomized trial comparing traditional and fast-track patient care in elective open infrarenal aneurysm repair. World J Surg, 2009, 33(3): 577-585.
11. Dokmak S, Ftériche FS, Borscheid R,et al. 2 012 liver resections in the 21st century: we are far from zero mortality. HPB (Oxford), 2013, 15(11): 908-915.
12. Dunne DF, Yip VS, Jones RP,et al. Enhanced recovery in the resection of colorectal liver metastases. J Surg Oncol, 2014, 110(2): 197-202.
13. Higgins JPT, Green S. Cochrance Handbook for Systematic Reviews of Interventions 5.1.0. The Cochrane Collaboration, 2011.
14. J?rgensen L, Paludan-Müller AS2, Laursen DR,et al. Evaluation of the Cochrane tool for assessing risk of bias in randomized clinical trials: overview of published comments and analysis of user practice in Cochrane and non-Cochrane reviews. Syst Rev, 2016, 5: 80.
15. 池閩輝, 曾永毅, 劉景豐. 快速康復外科在肝癌肝切除圍手術期的應用研究. 中國腫瘤臨床, 2012, 39(23): 1939-1942.
16. 黃海, 張洪昌, 莫世發, 等. 快速康復外科在腹腔鏡下精準肝切除患者中的應用. 中國內鏡雜志, 2013, 19(6): 603-606.
17. Lu H, Fan Y, Zhang F,et al. Fast-track surgery improves postoperative outcomes after hepatectomy. Hepatogastroen terology, 2014, 61(129): 168-172.
18. Jones C, Kelliher L, Dickinson M,et al. Randomized clinical trial on enhanced recoveryversus standard care following open liver resection. Br J Surg, 2013, 100(8): 1015-1024.
19. Ni CY, Yang Y, Chang YQ,et al. Fast-track surgery improves postoperative recovery in patients undergoing partial hepatectomy for primary liver cancer: A prospective randomized controlled trial. Eur J Surg Oncol, 2013, 39(6): 542-547.
20. 張傳國, 王慶寶, 張廣東, 等. 加速康復外科在肝葉切除術中的應用. 中國實用期刊, 2011, 38(15): 33-36.
21. 樊獻軍, 譚黃業, 肖詠梅, 等. 快速康復外科理念在肝癌圍手術期處理中的應用. 中國普通外科雜志, 2011, 20(7): 684-686.
22. Higgins JP, Altman DG, G?tzsche PC,et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
23. Kehlet H. Enhanced Recovery After Surgery (ERAS): good for now, but what about the future? Can J Anaesth, 2015, 62(2): 99-104.
24. Lemanu DP, Singh PP, Berridge K,et al. Randomized clinical trial of enhanced recovery versus standard care after laparoscopic sleeve gastrectomy. Br J Surg, 2013, 100(4): 482-489.
25. Stone AB, Grant MC, Pio Roda C,et al. Implementation costs of an enhanced recovery after surgery program in the United States: A financial model and sensitivity analysis based on experiences at a Quaternary Academic Medical Center. J Am Coll Surg, 2016, 222(3): 219-225.
26. Gustafsson UO, Scott MJ, Schwenk W,et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS^?) Society recommendations.Clin Nutr, 2012, 31(6): 783-800.
27. Lassen K, Coolsen MM, Slim K,et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS^?) Society recommendations. World J Surg, 2013, 37(2): 240-258.
28. Mortensen K, Nilsson M, Slim K,et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS^?) Society recommendations. Br J Surg, 2014, 101(10): 1209-1229.
29. 徐瑜杰, 王震, 陳俊強. 快速康復外科在胃癌根治術中應用的系統評價. 中國普外基礎與臨床雜志, 2015, 22(4): 423-433.
30. Melloul E, Hübner M, Scott M,et al. Guidelines for perioperative care for liver surgery: enhanced recovery after surgery (ERAS) society recommendations.World J Surg, 2016, 40(10): 2425-2440.
31. Coolsen MM, Wong-Lun-Hing EM, van Dam RM,et al. A systematic review of outcomes in patients undergoing liver surgery in an enhanced recovery after surgery pathways. HPB (Oxford), 2013, 15(4): 245-251.
32. Hughes MJ, McNally S, Wigmore SJ. Enhanced recovery following liver surgery: a systematic review and meta-analysis. HPB (Oxford), 2014, 16(8): 699-706.
33. Song W, Wang K, Zhang RJ,et al. The enhanced recovery after surgery (ERAS) program in liver surgery: a meta-analysis of randomized controlled trials. Springerplus, 2016, 5: 207.
34. Resanovic A, Zdravkovic D, Resanovic V,et al. Comparison of functional recovery is crucial for implementing ERAS. World J Surg, 2017, 41(1): 320-321.

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Application of enhanced recovery after surgery in liver resection during perioperative period

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