Ann Surg Treat Res.  2020 Dec;99(6):320-328. 10.4174/astr.2020.99.6.320.

Effect of enhanced recovery after surgery protocol on recovery after open hepatectomy: a randomized clinical trial

• Nakanishi W
• Miyagi S
• Tokodai K
• Fujio A
• Sasaki K
• Shono Y
• Unno M
• Kamei T

• KMID: 2508931
• DOI: http://doi.org/10.4174/astr.2020.99.6.320

Abstract

Purpose
Enhanced recovery after surgery (ERAS) is beneficial to patients undergoing digestive surgery. However, its efficacy in patients undergoing open hepatectomy remains unclear.
Methods
Consecutive patients scheduled for open hepatectomy were randomly assigned to undergo either ERAS or conventional postoperative management. The primary endpoint was the amount of time that elapsed before patients were considered medically fit for discharge (MFD) and length of hospital stay (LOHS). Secondary endpoints included morbidity, mortality, the time to first flatus, defecation, first walk, and freedom from infusion. Perioperative serum nutritional markers, insulin resistance, respiratory quotient (RQ), and resting energy expenditure (REE) were also assessed.
Results
Between August 2014 and March 2017, 57 patients were randomized into 2 groups; ERAS group (n = 29) and conventional management (n = 28). The median MFD was not significantly different between the ERAS and conventional management groups (6.5 vs. 7 days; P = 0.381). Recovery from gastrointestinal paresis was significantly quicker in the ERAS group (1.8 vs. 2.4 days; P = 0.004). There were no significant differences in serum markers, insulin resistance, RQ, and REE.
Conclusion
This trial did not demonstrate greater efficacy of the ERAS protocol following open hepatectomy in terms of the MFD and LOHS. However, the ERAS protocol was associated with better recovery from postoperative gastrointestinal paresis, suggesting that it is useful for patients undergoing open hepatectomy.

Keyword

Enhanced recovery after surgery; Hepatectomy; Perioperative treatments; Randomized controlled trial

Figure

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  Fig. 1 Patient disposition. ERAS, enhanced recovery after surgery.

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  Fig. 2 Mean (standard error of the mean) changes in serum markers from before surgery to postoperative day 7. BTR, branched amino acids/tyrosine molecular ratio; CONUT, Controlling Nutritional Status; Pre, preoperative.

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  Fig. 3 Mean (standard error of the mean) changes in homeostasis model assessment of insulin resistance (HOMA-IR) from before surgery to postoperative day (POD) 7. Pre, preoperative.

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  Fig. 4 Indirect calorimetry. (A) Comparison of respiratory quotient (RQ) before surgery and on postoperative day (POD) 7 in all patients. (B) Comparison of RQ between the enhanced recovery after surgery (ERAS) and conventional management groups before surgery and on POD 7. (C) Comparison of resting energy expenditure (REE) before surgery and on POD 7 in all patients. (D) Comparison of REE between the ERAS and conventional management groups before surgery and on POD 7. *P < 0.001.

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