Ann Hepatobiliary Pancreat Surg.  2020 May;24(2):119-126. 10.14701/ahbps.2020.24.2.119.

ERAS in minimally invasive hepatectomy

• Fung AKY
• Chong CCN
• Lai PBS

• KMID: 2500771
• DOI: http://doi.org/10.14701/ahbps.2020.24.2.119

Abstract

Open hepatectomy is associated with significant post-operative morbidity and mortality profile. The use of minimally invasive approach for hepatectomy can reduce the post-operative complication profile and total length of hospital stay. Enhanced recovery after surgery (ERAS) programs involve evidence-based multimodal care pathways designed to achieve early recovery for patients undergoing major surgery. This review will discuss the published evidence, challenges and future directions for ERAS in minimally invasive hepatectomy.

Keyword

Enhanced recovery; Minimally invasive; Hepatectomy

Reference

1. Benzoni E, Molaro R, Cedolini C, Favero A, Cojutti A, Lorenzin D, et al. 2007; Liver resection for HCC: analysis of causes and risk factors linked to postoperative complications. Hepatogastroenterology. 54:186–189. PMID: 17419257.

2. Cescon M, Vetrone G, Grazi GL, Ramacciato G, Ercolani G, Ravaioli M, et al. 2009; Trends in perioperative outcome after hepatic resection: analysis of 1500 consecutive unselected cases over 20 years. Ann Surg. 249:995–1002. DOI: 10.1097/SLA.0b013e3181a63c74. PMID: 19474679.

3. Ratti F, Cipriani F, Reineke R, Catena M, Comotti L, Beretta L, et al. 2016; Impact of ERAS approach and minimally-invasive techniques on outcome of patients undergoing liver surgery for hepatocellular carcinoma. Dig Liver Dis. 48:1243–1248. DOI: 10.1016/j.dld.2016.06.032. PMID: 27522551.

4. Dokmak S, Ftériche FS, Borscheid R, Cauchy F, Farges O, Belghiti J. 2013; 2012 Liver resections in the 21st century: we are far from zero mortality. HPB (Oxford). 15:908–915. DOI: 10.1111/hpb.12069. PMID: 23461811. PMCID: PMC4503289.

5. Mavros MN, de Jong M, Dogeas E, Hyder O, Pawlik TM. 2013; Impact of complications on long-term survival after resection of colorectal liver metastases. Br J Surg. 100:711–718. DOI: 10.1002/bjs.9060. PMID: 23364914.

6. Hughes MJ, Chong J, Harrison E, Wigmore S. 2016; Short-term outcomes after liver resection for malignant and benign disease in the age of ERAS. HPB (Oxford). 18:177–182. DOI: 10.1016/j.hpb.2015.10.011. PMID: 26902137. PMCID: PMC4814591.

7. Coolsen MM, Wong-Lun-Hing EM, van Dam RM, van der Wilt AA, Slim K, Lassen K, et al. 2013; A systematic review of outcomes in patients undergoing liver surgery in an enhanced recovery after surgery pathways. HPB (Oxford). 15:245–251. DOI: 10.1111/j.1477-2574.2012.00572.x. PMID: 23458424. PMCID: PMC3608977.

8. Ni CY, Yang Y, Chang YQ, Cai H, Xu B, Yang F, et al. 2013; Fast-track surgery improves postoperative recovery in patients undergoing partial hepatectomy for primary liver cancer: a prospective randomized controlled trial. Eur J Surg Oncol. 39:542–547. DOI: 10.1016/j.ejso.2013.03.013. PMID: 23562361.

9. Ni TG, Yang HT, Zhang H, Meng HP, Li B. 2015; Enhanced recovery after surgery programs in patients undergoing hepatectomy: a meta-analysis. World J Gastroenterol. 21:9209–9216. DOI: 10.3748/wjg.v21.i30.9209. PMID: 26290648. PMCID: PMC4533053.

10. Hughes MJ, McNally S, Wigmore SJ. 2014; Enhanced recovery following liver surgery: a systematic review and meta-analysis. HPB (Oxford). 16:699–706. DOI: 10.1111/hpb.12245. PMID: 24661306. PMCID: PMC4113251.

11. Nguyen KT, Gamblin TC, Geller DA. 2009; World review of laparoscopic liver resection-2,804 patients. Ann Surg. 250:831–841. DOI: 10.1097/SLA.0b013e3181b0c4df. PMID: 19801936.

12. Kehlet H, Wilmore DW. 2008; Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 248:189–198. DOI: 10.1097/SLA.0b013e31817f2c1a. PMID: 18650627.

13. Manso M, Schmelz J, Aloia T. 2017; ERAS-Anticipated outcomes and realistic goals. J Surg Oncol. 116:570–577. DOI: 10.1002/jso.24791. PMID: 28873504.

14. Bolshinsky V, Li MH, Ismail H, Burbury K, Riedel B, Heriot A. 2018; Multimodal prehabilitation programs as a bundle of care in gastrointestinal cancer surgery: a systematic review. Dis Colon Rectum. 61:124–138. DOI: 10.1097/DCR.0000000000000987. PMID: 29219922.

15. Le Roy B, Selvy M, Slim K. 2016; The concept of prehabilitation: what the surgeon needs to know? J Visc Surg. 153:109–112. DOI: 10.1016/j.jviscsurg.2016.01.001. PMID: 26851994.

16. Lillemoe HA, Aloia TA. 2018; Enhanced recovery after surgery: hepatobiliary. Surg Clin North Am. 98:1251–1264. DOI: 10.1016/j.suc.2018.07.011. PMID: 30390857. PMCID: PMC6345553.

17. Day RW, Cleeland CS, Wang XS, Fielder S, Calhoun J, Conrad C, et al. 2015; Patient-reported outcomes accurately measure the value of an enhanced recovery program in liver surgery. J Am Coll Surg. 221:1023–1030. e1–e2. DOI: 10.1016/j.jamcollsurg.2015.09.011. PMID: 26611799.

18. Morrison B, Kelliher L, Jones C. 2018; Enhanced recovery for liver resection-early recovery pathway for hepatectomy: data-driven liver resection care and recovery. Hepatobiliary Surg Nutr. 7:217–220. DOI: 10.21037/hbsn.2018.03.13. PMID: 30046579. PMCID: PMC6036071.

19. Kaibori M, Matsui K, Ishizaki M, Iida H, Yoshii K, Asano H, et al. 2017; Effects of implementing an "enhanced recovery after surgery" program on patients undergoing resection of hepatocellular carcinoma. Surg Today. 47:42–51. DOI: 10.1007/s00595-016-1344-2. PMID: 27165267.

20. Dasari BV, Rahman R, Khan S, Bennett D, Hodson J, Isaac J, et al. 2015; Safety and feasibility of an enhanced recovery pathway after a liver resection: prospective cohort study. HPB (Oxford). 17:700–706. DOI: 10.1111/hpb.12447. PMID: 26099347. PMCID: PMC4527855.

21. van Dam RM, Hendry PO, Coolsen MM, Bemelmans MH, Lassen K, Revhaug A, et al. 2008; Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection. Br J Surg. 95:969–975. DOI: 10.1002/bjs.6227. PMID: 18618897.

22. Jones C, Kelliher L, Dickinson M, Riga A, Worthington T, Scott MJ, et al. 2013; Randomized clinical trial on enhanced recovery versus standard care following open liver resection. Br J Surg. 100:1015–1024. DOI: 10.1002/bjs.9165. PMID: 23696477.

23. Kapritsou M, Korkolis DP, Giannakopoulou M, Kaklamanos I, Konstantinou M, Katsoulas T, et al. 2018; Fast-track recovery program after major liver resection: a randomized prospective study. Gastroenterol Nurs. 41:104–110. DOI: 10.1097/SGA.0000000000000306. PMID: 29596123.

24. Ovaere S, Boscart I, Parmentier I, Steelant PJ, Gabriel T, Allewaert J, et al. 2018; The effectiveness of a clinical pathway in liver surgery: a case-control study. J Gastrointest Surg. 22:684–694. DOI: 10.1007/s11605-017-3653-1. PMID: 29274000.

25. Wu SJ, Xiong XZ, Lu J, Cheng Y, Lin YX, Zhou RX, et al. 2015; Fast-track programs for liver surgery: a meta-analysis. J Gastrointest Surg. 19:1640–1652. DOI: 10.1007/s11605-015-2879-z. PMID: 26160321.

26. Yang R, Tao W, Chen YY, Zhang BH, Tang JM, Zhong S, et al. 2016; Enhanced recovery after surgery programs versus traditional perioperative care in laparoscopic hepatectomy: a meta-analysis. Int J Surg. 36(Pt A):274–282. DOI: 10.1016/j.ijsu.2016.11.017. PMID: 27840308.

27. Song W, Wang K, Zhang RJ, Dai QX, Zou SB. 2016; The enhanced recovery after surgery (ERAS) program in liver surgery: a meta-analysis of randomized controlled trials. Springerplus. 5:207. DOI: 10.1186/s40064-016-1793-5. PMID: 27026903. PMCID: PMC4770001.

28. Li M, Zhang W, Jiang L, Yang J, Yan L. 2016; Fast track for open hepatectomy: a systemic review and meta-analysis. Int J Surg. 36(Pt A):81–89. DOI: 10.1016/j.ijsu.2016.10.019. PMID: 27773599.

29. Brustia R, Slim K, Scatton O. 2019; Enhanced recovery after liver surgery. J Visc Surg. 156:127–137. DOI: 10.1016/j.jviscsurg.2018.10.007. PMID: 30447936.

30. Edwin B, Nordin A, Kazaryan AM. 2011; Laparoscopic liver surgery: new frontiers. Scand J Surg. 100:54–65. DOI: 10.1177/145749691110000110. PMID: 21482506.

31. Lin NC, Nitta H, Wakabayashi G. 2013; Laparoscopic major hepatectomy: a systematic literature review and comparison of 3 techniques. Ann Surg. 257:205–213. DOI: 10.1097/SLA.0b013e31827da7fe. PMID: 23263192.

32. Twaij A, Pucher PH, Sodergren MH, Gall T, Darzi A, Jiao LR. 2014; Laparoscopic vs open approach to resection of hepatocellular carcinoma in patients with known cirrhosis: systematic review and meta-analysis. World J Gastroenterol. 20:8274–8281. DOI: 10.3748/wjg.v20.i25.8274. PMID: 25009403. PMCID: PMC4081703.

33. Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, et al. 2015; Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg. 261:619–629. DOI: 10.1097/SLA.0000000000001184. PMID: 25742461.

34. Warner SG, Jutric Z, Nisimova L, Fong Y. 2017; Early recovery pathway for hepatectomy: data-driven liver resection care and recovery. Hepatobiliary Surg Nutr. 6:297–311. DOI: 10.21037/hbsn.2017.01.18. PMID: 29152476. PMCID: PMC5673763.

35. Alkhalili E, Berber E. 2014; Laparoscopic liver resection for malignancy: a review of the literature. World J Gastroenterol. 20:13599–13606. DOI: 10.3748/wjg.v20.i37.13599. PMID: 25309091. PMCID: PMC4188912.

36. Stoot JH, van Dam RM, Busch OR, van Hillegersberg R, De Boer M, Olde Damink SW, et al. 2009; The effect of a multimodal fast-track programme on outcomes in laparoscopic liver surgery: a multicentre pilot study. HPB (Oxford). 11:140–144. DOI: 10.1111/j.1477-2574.2009.00025.x. PMID: 19590638. PMCID: PMC2697877.

37. Liang X, Ying H, Wang H, Xu H, Yu H, Cai L, et al. 2016; Enhanced recovery program versus traditional care in laparoscopic hepatectomy. Medicine (Baltimore). 95:e2835. DOI: 10.1097/MD.0000000000002835. PMID: 26937913. PMCID: PMC4779010.

38. He F, Lin X, Xie F, Huang Y, Yuan R. 2015; The effect of enhanced recovery program for patients undergoing partial laparoscopic hepatectomy of liver cancer. Clin Transl Oncol. 17:694–701. DOI: 10.1007/s12094-015-1296-9. PMID: 25997686.

39. Sánchez-Pérez B, Aranda-Narváez JM, Suárez-Muñoz MA, Eladel-Delfresno M, Fernández-Aguilar JL, Pérez-Daga JA, et al. 2012; Fast-track program in laparoscopic liver surgery: theory or fact? World J Gastrointest Surg. 4:246–250. DOI: 10.4240/wjgs.v4.i11.246. PMID: 23493957. PMCID: PMC3596505.

40. Ratti F, Cipriani F, Reineke R, Comotti L, Paganelli M, Catena M, et al. 2018; The clinical and biological impacts of the implementation of fast-track perioperative programs in complex liver resections: a propensity score-based analysis between the open and laparoscopic approaches. Surgery. 164:395–403. DOI: 10.1016/j.surg.2018.04.020. PMID: 29887422.

41. Wong-Lun-Hing EM, van Dam RM, van Breukelen GJ, Tanis PJ, Ratti F, van Hillegersberg R, et al. 2017; Randomized clinical trial of open versus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery after surgery programme (ORANGE II study). Br J Surg. 104:525–535. DOI: 10.1002/bjs.10438. PMID: 28138958.

42. Hammond JS, Guha IN, Beckingham IJ, Lobo DN. 2011; Prediction, prevention and management of postresection liver failure. Br J Surg. 98:1188–1200. DOI: 10.1002/bjs.7630. PMID: 21725970.

43. Zimmitti G, Roses RE, Andreou A, Shindoh J, Curley SA, Aloia TA, et al. 2013; Greater complexity of liver surgery is not associated with an increased incidence of liver-related complications except for bile leak: an experience with 2,628 consecutive resections. J Gastrointest Surg. 17:57–64. discussion 64–65. DOI: 10.1007/s11605-012-2000-9. PMID: 22956403. PMCID: PMC3855461.

44. Poon RT, Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, et al. 2004; Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg. 240:698–708. discussion 708–710. DOI: 10.1097/01.sla.0000141195.66155.0c. PMID: 15383797. PMCID: PMC1356471.

45. Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, et al. 2002; Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 236:397–406. discussion 406–407. DOI: 10.1097/00000658-200210000-00001. PMID: 12368667. PMCID: PMC1422593.

46. Fong Y, Brennan MF, Brown K, Heffernan N, Blumgart LH. 1996; Drainage is unnecessary after elective liver resection. Am J Surg. 171:158–162. DOI: 10.1016/S0002-9610(99)80092-0. PMID: 8554132.

47. Petrowsky H, Demartines N, Rousson V, Clavien PA. 2004; Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg. 240:1074–1084. discussion 1084–1085. DOI: 10.1097/01.sla.0000146149.17411.c5. PMID: 15570212. PMCID: PMC1356522.

48. Belghiti J, Kabbej M, Sauvanet A, Vilgrain V, Panis Y, Fekete F. 1993; Drainage after elective hepatic resection. A randomized trial. Ann Surg. 218:748–753. DOI: 10.1097/00000658-199312000-00008. PMID: 8257225. PMCID: PMC1243070.

49. Squires MH 3rd, Lad NL, Fisher SB, Kooby DA, Weber SM, Brinkman A, et al. 2015; Value of primary operative drain placement after major hepatectomy: a multi-institutional analysis of 1,041 patients. J Am Coll Surg. 220:396–402. DOI: 10.1016/j.jamcollsurg.2014.12.029. PMID: 25724607.

50. Pessaux P, Regimbeau JM, Dondéro F, Plasse M, Mantz J, Belghiti J. 2007; Randomized clinical trial evaluating the need for routine nasogastric decompression after elective hepatic resection. Br J Surg. 94:297–303. DOI: 10.1002/bjs.5728. PMID: 17315273.

51. Pessaux P, van den Broek MA, Wu T, Olde Damink SW, Piardi T, Dejong CH, et al. 2013; Identification and validation of risk factors for postoperative infectious complications following hepatectomy. J Gastrointest Surg. 17:1907–1916. DOI: 10.1007/s11605-013-2226-1. PMID: 23661000.

52. Spetzler VN, Schepers M, Pinnschmidt HO, Fischer L, Nashan B, Li J. 2019; The incidence and severity of post-hepatectomy bile leaks is affected by surgical indications, preoperative chemotherapy, and surgical procedures. Hepatobiliary Surg Nutr. 8:101–110. DOI: 10.21037/hbsn.2019.02.06. PMID: 31098357. PMCID: PMC6503260.

53. Yin Z, Fan X, Ye H, Yin D, Wang J. 2013; Short- and long-term outcomes after laparoscopic and open hepatectomy for hepatocellular carcinoma: a global systematic review and meta-analysis. Ann Surg Oncol. 20:1203–1215. DOI: 10.1245/s10434-012-2705-8. PMID: 23099728.

54. Ho AM, Lee A, Karmakar MK, Samy W, Lai PB, Ho OA, et al. 2007; Hemostatic parameters after hepatectomy for cancer. Hepatogastroenterology. 54:1494–1498. PMID: 17708283.

55. Carli F. 2015; Physiologic considerations of Enhanced Recovery After Surgery (ERAS) programs: implications of the stress response. Can J Anaesth. 62:110–119. DOI: 10.1007/s12630-014-0264-0. PMID: 25501695.

56. Sakowska M, Docherty E, Linscott D, Connor S. 2009; A change in practice from epidural to intrathecal morphine analgesia for hepato-pancreato-biliary surgery. World J Surg. 33:1802–1808. DOI: 10.1007/s00268-009-0131-2. PMID: 19548026.

57. Page A, Rostad B, Staley CA, Levy JH, Park J, Goodman M, et al. 2008; Epidural analgesia in hepatic resection. J Am Coll Surg. 206:1184–1192. DOI: 10.1016/j.jamcollsurg.2007.12.041. PMID: 18501817.

58. Hughes M, McNally S, McKeown DW, Wigmore S. 2015; Effect of analgesic modality on outcome following open liver surgery: a systematic review of postoperative analgesia. Minerva Anestesiol. 81:541–556. PMID: 24918191.

59. Sandström R, Drott C, Hyltander A, Arfvidsson B, Scherstén T, Wickström I, et al. 1993; The effect of postoperative intravenous feeding (TPN) on outcome following major surgery evaluated in a randomized study. Ann Surg. 217:185–195. DOI: 10.1097/00000658-199302000-00013. PMID: 8439216. PMCID: PMC1242758.

60. Okabayashi T, Nishimori I, Yamashita K, Sugimoto T, Namikawa T, Maeda H, et al. 2010; Preoperative oral supplementation with carbohydrate and branched-chain amino acid-enriched nutrient improves insulin resistance in patients undergoing a hepatectomy: a randomized clinical trial using an artificial pancreas. Amino Acids. 38:901–907. DOI: 10.1007/s00726-009-0297-9. PMID: 19399583.

61. Soop M, Nygren J, Myrenfors P, Thorell A, Ljungqvist O. 2001; Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance. Am J Physiol Endocrinol Metab. 280:E576–E583. DOI: 10.1152/ajpendo.2001.280.4.E576. PMID: 11254464.

62. Melloul E, Hübner M, Scott M, Snowden C, Prentis J, Dejong CH, et al. 2016; Guidelines for perioperative care for liver surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World J Surg. 40:2425–2440. DOI: 10.1007/s00268-016-3700-1. PMID: 27549599.

63. Abeles A, Kwasnicki RM, Darzi A. 2017; Enhanced recovery after surgery: current research insights and future direction. World J Gastrointest Surg. 9:37–45. DOI: 10.4240/wjgs.v9.i2.37. PMID: 28289508. PMCID: PMC5329702.

64. Lyon A, Payne CJ, Mackay GJ. 2012; Enhanced recovery programme in colorectal surgery: does one size fit all? World J Gastroenterol. 18:5661–5663. DOI: 10.3748/wjg.v18.i40.5661. PMID: 23155304. PMCID: PMC3484332.

65. Pearsall EA, Meghji Z, Pitzul KB, Aarts MA, McKenzie M, McLeod RS, et al. 2015; A qualitative study to understand the barriers and enablers in implementing an enhanced recovery after surgery program. Ann Surg. 261:92–96. DOI: 10.1097/SLA.0000000000000604. PMID: 24646564.

66. Day RW, Fielder S, Calhoun J, Kehlet H, Gottumukkala V, Aloia TA. 2015; Incomplete reporting of enhanced recovery elements and its impact on achieving quality improvement. Br J Surg. 102:1594–1602. DOI: 10.1002/bjs.9918. PMID: 26364714. PMCID: PMC4838394.

67. Teixeira UF, Goldoni MB, Waechter FL, Sampaio JA, Mendes FF, Fontes PRO. 2019; Enhanced recovery (ERAS) after liver surgery: comparative study in a Brazilian terciary center. Arq Bras Cir Dig. 32:e1424. DOI: 10.1590/0102-672020180001e1424. PMID: 30758472. PMCID: PMC6368150.

68. Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP. 2002; Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet. 359:1812–1818. DOI: 10.1016/S0140-6736(02)08711-1. PMID: 12044376.

69. Kehlet H, Rung GW, Callesen T. 1996; Postoperative opioid analgesia: time for a reconsideration? J Clin Anesth. 8:441–445. DOI: 10.1016/0952-8180(96)00131-6. PMID: 8872683.