Individualized Enhanced Recovery After Surgery (Eras) Protocols for Patients with Hepatocellular Carcinoma: A Retrospective Study

Abstract

Background: Hepatocellular carcinoma (HCC) patients often undergo curative liver resection to treat this form of cancer. Hepatectomy is, however, a form of major surgery associated with many significant risks including prolonged hospitalization, high costs, impaired physiological function, and high postoperative complication rates. Enhanced recovery after surgery (ERAS) is a multidisciplinary approach that seeks to expedite postoperative recovery in patients undergoing major surgeries in order to lower postoperative complication rates. Prior studies have successfully employed ERAS approaches in the context of gynecological, urological, and cardiovascular surgeries. However, HCC is a complex disease and affected patients may also suffer from pre-existing liver disease, making it essential that they be administered appropriate individually tailored treatments. This study was thus designed to assess the efficacy and safety of individualized ERAS approaches in patients undergoing hepatectomy.

Methods: In total, we retrospectively analyzed data from 90 HCC patients that underwent hepatectomy between October 2018 and August 2019. All patients met the study enrolment criteria and provided written informed consent to participate. All studies were approved by the Hospital Research Ethics Committee and were consistent with the Declaration of Helsinki. Patients were randomly divided into two groups (n=45 each) based on the employed perioperative treatment strategies: a conventional treatment group and an ERAS treatment group. Key outcomes were then compared between groups, including postoperative pain scores, duration of postoperative hospitalization, medical costs, and rates of readmission. Quantitative data are given as `x±s and were compared via Student’s t-tests, whereas categorical data were compared via chi-squared tests and Fisher's exact test.

Results: ERAS treatment was associated with lower postoperative pain scores at 24, 48, and 72 h post-treatment (P<0.05), with a shorter postoperative hospitalization duration (8.16 days vs.10.49 days; P<0.004), and with lower medical costs (P<0.004) as compared to traditional treatment. No significant differences in complication rates (P>0.05) or readmission rates (P>0.557) were observed between these groups.

Conclusion: Individualized ERAS improves patient postoperative recovery more effectively than traditional treatment in patients undergoing hepatectomy.