Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
Northwest Hepatobiliary Centre, University Hospital Aintree, Liverpool, UK.
Eur J Surg Oncol. 2019 Aug;45(8):1439-1445. doi: 10.1016/j.ejso.2019.03.033. Epub 2019 Mar 28.
Enhanced recovery after surgery (ERAS) for peri-hilar cholangiocarcinoma (pCCA) has not been described in the literature. This study examined patients undergoing pCCA resection within a standard post hepatectomy ERAS pathway to define achievable targets suitable for these patients.
Patients undergoing pCCA resection at University Hospital Aintree (January 2009-October 2017) were identified. Achievement of key ERAS outcomes was assessed. Patients were stratified on incidence of major complications and pre-operative cardiopulmonary exercise testing. Chi Square and Mann Whitney analyses were undertaken as appropriate. Achievable ERAS targets were derived from patients who did not develop a major complication.
46 patients underwent resection with enhanced recovery. Median age 65 (24 male: 22 female). Key ERAS outcomes in patients who did not experience major complications are described as medians (interquartile range): length of stay 8 days (6-13), duration critical care 2 days (2-4), inotropes 6 h (0-24), epidural 3 days (3-4), early mobilization day 1 (1-2), full mobilization day 3 (3-4), urinary catheter removal day 4 (3-5), NGT removal day 1 (1-2) and restoration oral nutrition day 2 (2-4). Patients deemed high risk pre-operatively or those who developed major complications post-operatively required significantly longer critical care (p = 0.008 and p = 0.002 respectively). Other ERAS targets remained achievable in similar timeframes.
ERAS for pCCA is achievable. Applicable ERAS standards are defined which take into account minor complications. High risk patients and those with major complications can be appropriately managed in an ERAS pathway, though there is increased need for critical care support.
围肝门胆管癌（pCCA）的术后快速康复（ERAS）在文献中尚未描述。本研究通过检查接受 pCCA 切除术的患者在标准的肝切除术后 ERAS 路径内，以确定适合这些患者的可实现目标。
在阿因特里大学医院（2009 年 1 月至 2017 年 10 月）确定接受 pCCA 切除术的患者。评估关键 ERAS 结果的实现情况。根据主要并发症和术前心肺运动测试的发生率对患者进行分层。根据未发生重大并发症的患者，推导出可实现的 ERAS 目标。
46 例患者接受了增强恢复的切除术。中位年龄 65 岁（24 名男性：22 名女性）。未发生重大并发症的患者的关键 ERAS 结果描述为中位数（四分位距）：住院时间 8 天（6-13）、重症监护时间 2 天（2-4）、使用正性肌力药 6 小时（0-24）、硬膜外 3 天（3-4）、早期活动第 1 天（1-2）、完全活动第 3 天（3-4）、导尿管拔除第 4 天（3-5）、NGT 拔除第 1 天（1-2）和恢复口服营养第 2 天（2-4）。术前风险较高或术后发生重大并发症的患者需要更长时间的重症监护（p=0.008 和 p=0.002）。其他 ERAS 目标在类似的时间内仍然可以实现。
pCCA 的 ERAS 是可行的。定义了适用的 ERAS 标准，这些标准考虑了轻微并发症。高危患者和有重大并发症的患者可以在 ERAS 路径中得到适当的管理，尽管需要更多的重症监护支持。
