Enhanced Recovery After Liver Surgery

The first postoperative fast-track protocols, also called “enhanced recovery after surgery” (ERAS), were instituted by colorectal surgeons almost three decades ago in order to modulate surgical stress and hasten recovery. Since then, the implementation of enhanced recovery programs has had an exponential expansion across most surgical specialties, including gynecology, urology, breast, vascular, and orthopedic surgery.

ERAS_Liver_Surgery_1

“Enhanced recovery after liver surgery” (ERLS) was first introduced in 2008 and has incrementally gained acceptance as being an integral part of perioperative care for hepatectomy patients. Several outcome metrics have shown to be improved with the adoption of a multimodal evidencebased strategy in liver surgery, many of which are also shared by other surgical specialties practicing in an enhanced recovery framework.

Improved clinical outcomes such as length of stay, morbidity rates, and hospital costs tend to support implementation of fast-track programs in general, but other metrics specific to liver surgery and to patients with colorectal liver metastases (CLM) further endorse this strategy when managing CLM. The implementation of an ERLS program represents a collaborative approach in which the different team players, including anesthesia, surgery, nutrition, pharmacy, nursing, and most importantly the patient and his/her family, engage actively in the perioperative pathway, in an evidence-based, patient-centered approach. The development of such programs also requires dedicated continuing education for the team members, flexibility in terms of perioperative management and decisionmaking by the health-care providers, support from the hospital administration, and systematic quality control measures to ensure implementation and accurate reporting. This review study the different core elements of ERLS and discuss different outcomes associated with this system-based approach, with an emphasis on oncological patients.

ERAS_Liver_Surgery

Interference with oncological treatment plans can negatively affect patients’ longterm outcomes but can also be detrimental to quality of life and overall functional status. Patient-reported outcomes (PROs) attempt to capture the patients’ perspective for a given intervention or treatment strategy, which are particularly important in oncological patients. Day et al. reported that the implementation of ERLS was beneficial for patients in terms of functional recovery, and although no significant differences were detected in terms of symptom burden, the impact of ERLS was shown to accelerate functional recovery by returning to baseline interference earlier. This positive effect from ERLS seems more pronounced in patients undergoing open hepatectomy over those already benefiting from minimally invasive surgery.ERAS_ABDOMINAL SURGERY

2 Respostas

  1. […] of 7 and 22 days. In addition to the pioneering conceptual framework and implementation of LT, the advanced techniques included grafts from non–heart-beating donors, venovenous bypass in the recipients, […]

  2. […] Minimal future liver remnant requirementsLiver resection remains the treatment of choice for HCC. Two major preoperative considerations for HCC resection are the patient’s liver function and the predicted future liver remnant (FLR). The intrinsic liver function of patients with HCC is often impaired because this patient population generally has chronic liver disease, including viral hepatitis, alcoholic hepatitis, and nonalcoholic steatohepatitis. As such, studies reportthat more FLR is needed for patients undergoing resection for HCC than for patients undergoing resection of secondary liver cancer (ie, metastatic disease). The minimal requirement of FLR/standardized liver volume (standardized liver volume 5 x 794 1 1267.28 x body surface area) is 30% in patients with hepatic injury and fibrosis and 40% in patients with cirrhosis, whereas it is 20% to 25% for patients with normal liver. […]

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