Yang Xu1, Pei-Yao Fu1, Wei-Dong Jia3, Qiang-Xia4, Kui-Wang5, Dou-Sheng Bai6, Bo Hu1, Hui-Chuan Sun1, Qin-Hai Ye1, Xiao-Ying Wang1, Ying-Hong Shi1, Shuang-Jian Qiu1, Jia Fan1,2 and Jian Zhou1,2*
1Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, China
2Institute of Biomedical Sciences, Fudan University, China
3Department of General Surgery, Anhui Provincial Hospital, China
4Department of Liver Surgery, Renji Hospital, Jiaotong University, China
5Department of Liver Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, China
6Department of General Surgery, Subei People's Hospital, Yangzhou, China
Background: Enhanced Recovery after Surgery (ERAS) is a multimodal perioperative management approach that is used to accelerate recovery, reduce morbidity, and shorten hospital stay after major surgery. However, solid evidence that proves its safety and effectiveness in liver surgery for patients with Hepatocellular Carcinoma (HCC), which is always combined with liver cirrhosis and hepatitis infection in China, remains lacking. In this multicentre randomized controlled clinical trial, we compared ERAS and traditional treatment approach for HCC patients who underwent partial hepatectomy. Methods: A total of 222 HCC patients recruited from five medical centers in China were randomly assigned to ERAS and control groups (1:1) to compare the short-term effects of ERAS and those of conventional perioperative managements. Results: The overall complication rate in the ERAS group was significantly lower than that in the control group (25.2 vs. 45.9%, p<0.01). The mean length of postoperative hospital stays decreased from 8 to 7 days (p<0.01). The rates of vomiting (10.8 vs. 22.5%, p=0.02) and ascites (5.4 vs. 13.5%, p=0.03) in the ERAS group were significantly less than those in the control group. Pain and insulin resistance after surgery were significantly reduced in the ERAS group based on the visual analogue scale and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) score (all p<0.05). Conclusion: ERAS accelerated recovery in HCC patients who underwent partial hepatectomy, even those with liver cirrhosis.
Xu Y, Fu P-Y, Jia W-D, Qiang-Xia, Kui-Wang, Bai D-S, et al. Safety and Effectiveness of Enhanced Recovery after Surgery (ERAS) in Patients with Hepatocellular Carcinoma Undergoing Partial Hepatectomy: A Multicentre, Randomized, Controlled Clinical Study. Clin Surg. 2021; 6: 3278..