Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Surgery Today
Erschienen in: Surgery Today 1/2017

10.05.2016 | Original Article

Effects of implementing an “enhanced recovery after surgery” program on patients undergoing resection of hepatocellular carcinoma

verfasst von: Masaki Kaibori, Kosuke Matsui, Morihiko Ishizaki, Hiroya Iida, Kengo Yoshii, Hiroaki Asano, Masanori Kon

Erschienen in: Surgery Today | Ausgabe 1/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To evaluate the effects of implementing an “enhanced recovery after surgery” (ERAS) program on the feasibility, safety, and effectiveness of extensive and potentially curative liver resection for hepatocellular carcinoma (HCC).

Methods

We compared clinicopathologic factors, surgical factors, and outcomes of patients who underwent extended hepatectomy (defined as resection of more than two sections) for HCC, before and after the introduction of an ERAS program.

Results

Operating times and postoperative hospital stay were significantly shorter, and total volume infused during surgery was significantly lower, for the ERAS group than for the control group. Although the ERAS group had a significantly lower percentage of patients with retention of abdominal drainage, this group had a higher frequency of abdominal paracentesis in patients without intraoperative abdominal drainage. Oral dietary intake and the ability to walk steadily resumed significantly earlier in the ERAS group. Postoperative serum concentrations of albumin and cholinesterase were significantly higher in the ERAS group than in the control group.

Conclusions

The ERAS program was feasible and effective for patients with chronic liver disease undergoing extended liver resection for HCC, because it allowed earlier oral dietary intake and promoted faster postoperative recovery.
Literatur
1.
Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP. Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery. 2011;149:830–40.CrossRefPubMed
2.
Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, et al. Consensus review of optimal perioperative care in colorectal surgery: enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009;144:961–9.CrossRefPubMed
3.
Leibman BD, Dillioglugil O, Abbas F, Tanli S, Kattan MW, Scardino PT. Impact of a clinical pathway for radical retropublic prostatectomy. Urology. 1998;52:94–9.CrossRefPubMed
4.
Niino T, Hata M, Sezai A, Yoshitake I, Unosawa S, Shimura K, et al. Optimal clinical pathway for the patient with type B acute aortic dissection. Circ J. 2009;73:264–8.CrossRefPubMed
5.
Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev. 2011;2:CD007635. doi:10.​1002/​14651858.​CD007635.​pub2.
6.
Hall TC, Dennison AR, Biku DK, Metcalfe MS, Garcea G. Enhanced recovery programmes in hepatobiliary and pancreatic surgery: a systematic review. Ann R Coll Surg Engl. 2012;94:318–26.CrossRefPubMedPubMedCentral
7.
Page AJ, Ejaz A, Spolverato G, Zavadsky T, Grant MC, Galante DJ, et al. Enhanced recovery after surgery protocols for open hepatectomy-physiology, immnunomodulation, and implementation. J Gastrointest Surg. 2015;19:387–99.CrossRefPubMed
8.
Jones C, Kelliher L, Dickinson M, Riga A, Worthington T, Scott MJ, et al. Randomized clinical trial on enhanced recovery versus standard care following open liver resection. Br J Surg. 2013;100:1015–24.CrossRefPubMed
9.
Ni CY, Yang Y, Chang YQ, Cai H, Xu B, Yang F, et al. Fast-track surgery improves postoperative recovery in patients undergoing partial hepatectomy for primary liver cancer: a prospective randomized controlled trial. Eur J Surg Oncol. 2013;39:542–7.CrossRefPubMed
10.
Bosch X, Ribes J, Borras J. Epidemiology of primary liver cancer. Semin Liver Dis. 1999;19:271–85.CrossRefPubMed
11.
Taylor-Robinson SD, Foster GR, Arora S, Hargreaves S, Thomas HC. Increase in primary liver cancer in the UK 1979–94. Lancet. 1997;350:1142–3.CrossRefPubMed
12.
EI-Serag HB, Mason AC. Rising incidence of hepatocellular carcinoma in the US. N Engl J Med. 1999;340:745–50.CrossRef
13.
Nanashima A, Nagayasu T. Development and clinical usefulness of the liver hanging maneuver in various anatomical hepatectomy procedures. Surg Today. 2016;46:398–404.CrossRefPubMed
14.
Fan ST, Lai EC, Lo CM, Ng IO, Wong J. Hospital mortality of major hepatectomy for hepatocellular carcinoma associated with cirrhosis. Arch Surg. 1995;130:198–203.CrossRefPubMed
15.
Nadig DE, Wada TP, Fairchild RB, Virgo KS, Johnson FE. Major hepatic resection. Arch Surg. 1997;132:115–9.CrossRefPubMed
16.
Yeh CN, Chen MF, Lee WC, Jeng LB. Prognostic factors of hepatic resection for hepatocellular carcinoma with cirrhosis: univariate and multivariate analysis. J Surg Oncol. 2002;81:195–202.CrossRefPubMed
17.
Benzoni E, Cojutti A, Lorenzin D, Adani GL, Baccarani U, Favero A, et al. Liver resective surgery: a multivariate analysis of postoperative outcome and complication. Langenbecks Arch Surg. 2007;392:45–54.CrossRefPubMed
18.
Chiappa A, Zbar AP, Audisio RA, Leone BE, Biella F, Staudacher C. Factors affecting survival and long-term outcome in the cirrhotic patient undergoing hepatic resection for hepatocellular carcinoma. Eur J Surg Oncol. 2000;26:387–92.CrossRefPubMed
19.
Farges O, Malassagne B, Flejou JF, Balzan S, Sauvanet A, Belghiti J. Risk of major liver resection in patients with underlying chronic liver disease: a reappraisal. Ann Surg. 1999;229:210–5.CrossRefPubMedPubMedCentral
20.
Yamanaka N, Takata M, Tanaka T, Yamanaka J, Yasui C, Ando T, et al. Evolution of and obstacles in surgical treatment for hepatocellular carcinoma over the last 25 years: differences over four treatment eras. J Gastroenterol. 2000;35:613–21.CrossRefPubMed
21.
Makuuchi M. Remodeling the surgical approach to hepatocellular carcinoma. Hepatogastroenterology. 2002;49:36–40.PubMed
22.
Taketomi A, Kitagawa D, Itoh S, Harimoto N, Yamashita Y, Gion T, et al. Trends in morbidity and mortality after hepatic resection for hepatocellular carcinoma: an institute’s experience with 625 patients. J Am Coll Surg. 2007;204:580–7.CrossRefPubMed
23.
Strasberg SM, Belghiti J, Clavn P-A. The Brisbane 2000 terminology of liver anatomy and resection. Terminology Committee of the International Hepato-Pancreato-Biliary Association. HPB. 2000;2:333–9.
24.
Couinaud C, editor. Le Foie: Etudes Anatomiques et Chirurgicales. Paris: Masson; 1957.
25.
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.CrossRefPubMed
26.
27.
Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005;24:466–77.CrossRefPubMed
28.
Kaibori M, Ishizaki M, Matsui K, Nakatake R, Yoshiuchi S, Kimura Y, et al. Perioperative exercise for chronic liver injury patients with hepatocellular carcinoma undergoing hepatectomy. Am J Surg. 2013;206:202–9.CrossRefPubMed
29.
Lewis SJ, Egger M, Sylvester PA, Thomas S. Early enteral feeding versus ‘nil by mouth’ after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ. 2001;323:773–6.CrossRefPubMedPubMedCentral
30.
Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet. 2002;359:1812–8.CrossRefPubMed
31.
Kehlet H, Wilmpore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183:630–41.CrossRefPubMed
32.
Kaibori M, Ishizaki M, Matsui K, Kwon AH. Intraoperative indocyanine green fluorescent imaging for prevention of bile leakage after hepatic resection. Surgery. 2011;150:91–8.CrossRefPubMed
33.
Kenjo A, Miyata H, Gotoh M, Kitagawa Y, Shimada M, Baba H, et al. Risk stratification of 7732 hepatectomy cases in 2011 from the national clinical database for Japan. J Am Coll Surg. 2014;218:412–22.CrossRefPubMed
34.
Fong Y, Brennan MF, Brown K, Heffernan N, Blumgart LH. Drainage is unnecessary after elective liver resection. Am J Surg. 1996;171:158–62.CrossRefPubMed
35.
Petrowsky H, Demartines N, Rousson V, Clavien PA. Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg. 2004;240:1074–84.CrossRefPubMedPubMedCentral
36.
Belghiti J, Kabbej M, Sauvanet A, Vilgrain V, Panis Y, Fekete F. Drainage after elective hepatic resection. A randomized trial. Ann Surg. 1993;218:748–53.CrossRefPubMedPubMedCentral
37.
Burt BM, Brown K, Jarnajin W, DeMatteo R, Blumgart LH, Fong Y. An audit of results of a no-drainage practice policy after hepatectomy. Am J Surg. 2002;184:441–5.CrossRefPubMed
38.
Liu CL, Fan ST, Lo CM, Wong Y, Ng IO, Lam CM, et al. Abdominal drainage after hepatic resection is contraindicated in patients with chronic liver diseases. Ann Surg. 2004;239:194–201.CrossRefPubMedPubMedCentral
Metadaten
Titel
Effects of implementing an “enhanced recovery after surgery” program on patients undergoing resection of hepatocellular carcinoma
verfasst von
Masaki Kaibori
Kosuke Matsui
Morihiko Ishizaki
Hiroya Iida
Kengo Yoshii
Hiroaki Asano
Masanori Kon
Publikationsdatum
10.05.2016
Verlag
Springer Japan
Erschienen in
Surgery Today / Ausgabe 1/2017
Print ISSN: 0941-1291
Elektronische ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-016-1344-2

Weitere Artikel der Ausgabe 1/2017

Surgery Today 1/2017 Zur Ausgabe

Original Article

Postoperative complications following aggressive repeat hepatectomy for colorectal liver metastasis have adverse oncological outcomes

Review Article

No-touch isolation techniques for pancreatic cancer

Original Article

Modified Marcy repair for indirect inguinal hernia in children: a 24-year single-center experience of 6826 pediatric patients

Original Article

The impact on the prognosis of unsuspected N2 disease in non-small-cell lung cancer: indications for thorough mediastinal staging in the modern era

Short Communication

Duodenal-jejunal bypass changes the composition of the gut microbiota

Acknowledgment

Acknowledgment to reviewers

Leitlinien kompakt für die Allgemeinmedizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Kostenlos registrieren

Facharzt-Training Allgemeinmedizin

Die ideale Vorbereitung zur anstehenden Prüfung mit den ersten 24 von 100 klinischen Fallbeispielen verschiedener Themenfelder

Mehr erfahren

Neu im Fachgebiet Allgemeinmedizin

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Metformin rückt in den Hintergrund

24.04.2024 DGIM 2024 Kongressbericht

Es hat sich über Jahrzehnte klinisch bewährt. Doch wo harte Endpunkte zählen, ist Metformin als alleinige Erstlinientherapie nicht mehr zeitgemäß.

Myokarditis nach Infekt – Richtig schwierig wird es bei Profisportlern

24.04.2024 DGIM 2024 Kongressbericht

Unerkannte Herzmuskelentzündungen infolge einer Virusinfektion führen immer wieder dazu, dass junge, gesunde Menschen plötzlich beim Sport einen Herzstillstand bekommen. Gerade milde Herzbeteiligungen sind oft schwer zu diagnostizieren – speziell bei Leistungssportlern. 

Update Allgemeinmedizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise