Department of Visceral Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Department of Economics, HEC Lausanne, University of Lausanne (UNIL), Lausanne, Switzerland.
Langenbecks Arch Surg. 2020 Nov;405(7):959-966. doi: 10.1007/s00423-020-01981-1. Epub 2020 Sep 11.
Multidisciplinary approach with adjuvant chemotherapy is the key element to provide optimal outcomes in pancreas and liver malignancies. However, post-operative complications may increase the interval between surgery and chemotherapy with negative oncologic effects.
The aim of the study was to analyse whether compliance to Enhanced Recovery After Surgery (ERAS) pathway was associated with decreased interval to adjuvant chemotherapy.
Retrospective analysis of all consecutive ERAS patients with surgery for hepatobiliary or pancreatic malignancies at the University Hospital of Lausanne between 2012 and 2016. Multivariate analysis was performed to assess the impact of ERAS compliance on time to chemotherapy.
A total of 133 patients with adjuvant chemotherapy were included (n = 44 liver and n = 89 pancreatic cancer). Median compliance to ERAS was 61% (IQR 55-67) for the study population, and median delay to chemotherapy was 49 days (IQR 39-61). Overall, compliance ≥ 67% to ERAS induced a significant reduction in the interval between surgery and chemotherapy for young patients (< 65 years old) with or without severe comorbidities (reduction of 22 and 10 days, respectively). High compliance in young ASA3 patients with liver colorectal metastases was associated with an increase of 481 days of DFS.
ERAS compliance ≥ 67% tends to be associated with a reduction in the delay to adjuvant chemotherapy for young patients with hepatobiliary and pancreatic malignancies. More prospective studies with strict adhesion to the ERAS protocol are needed to confirm these results.
多学科方法联合辅助化疗是提供胰腺和肝脏恶性肿瘤最佳治疗效果的关键因素。然而，术后并发症可能会增加手术和化疗之间的时间间隔，从而产生不利的肿瘤学影响。
本研究旨在分析是否遵守加速康复外科（ERAS）方案与辅助化疗时间的缩短有关。
对 2012 年至 2016 年期间在洛桑大学医院接受肝胆或胰腺恶性肿瘤手术的连续 ERAS 患者进行回顾性分析。采用多变量分析评估 ERAS 依从性对化疗时间的影响。
共纳入 133 例接受辅助化疗的患者（44 例肝肿瘤和 89 例胰腺肿瘤）。研究人群中 ERAS 依从性中位数为 61%（IQR 55-67），化疗延迟中位数为 49 天（IQR 39-61）。总体而言，ERAS 依从性≥67%可显著缩短年轻患者（<65 岁）和/或合并严重合并症患者手术和化疗之间的间隔（分别减少 22 天和 10 天）。在年轻 ASA3 级肝转移性结直肠癌患者中，ERAS 高依从性与 DFS 增加 481 天相关。
ERAS 依从性≥67%可能与缩短肝胆胰腺恶性肿瘤年轻患者的辅助化疗延迟时间有关。需要更多具有严格遵守 ERAS 方案的前瞻性研究来证实这些结果。
