Zhang Zhao, Gu Weidong, Zhang Yijing
Nursing Department, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, People's Republic of China.
Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, People's Republic of China.
Cancer Manag Res. 2021 Mar 19;13:2681-2690. doi: 10.2147/CMAR.S301859. eCollection 2021.
The aim of this study was to evaluate the effects of implementation of the enhanced recovery after surgery (ERAS) program on postoperative recovery and the long-term prognosis in patients who underwent hepatectomy.
This retrospective study enrolled patients who underwent hepatectomy from January 2015 to December 2018 in Huadong Hospital Affiliated to Fudan University. Since June 2016, a 24-point ERAS protocol has been implemented for patients who underwent hepatic resection. The primary outcomes were overall survival (OS) and disease-free survival (DFS). The secondary outcomes included length of stay (LOS), and incidence of postoperative complications.
A total of 1143 patients were enrolled in this study. After propensity score matching (PSM), there was no significant difference in patients' demographic characteristics. The DFS at 1., 3 years in ERAS group was higher than in non-ERAS group (96.3% vs 88.9% for 1 year, P=0.012; 58.9% vs 46.7% for 3 years, P=0.007). The OS at 1, 3 years in ERAS group was higher than in non-ERAS group (93.1% vs 89.3% for 1 year, P=0.041; 68.7% vs 61.2% for 3 years, P=0.035). In addition, the patients in ERAS group had lower incidences of postoperative hemorrhage, bile leak, and postoperative deep vein thrombosis/pulmonary embolism (DVT/PE), decreased 30-day readmission rate and total readmission rate, and shorter LOS.
ERAS program could be safely applied to patients who underwent hepatectomy thereby improving their recovery and prolonging OS and DFS.
本研究旨在评估实施加速康复外科（ERAS）方案对肝切除患者术后恢复及长期预后的影响。
本回顾性研究纳入了2015年1月至2018年12月在复旦大学附属华东医院接受肝切除的患者。自2016年6月起，对接受肝切除的患者实施了一项包含24项内容的ERAS方案。主要结局为总生存期（OS）和无病生存期（DFS）。次要结局包括住院时间（LOS）及术后并发症发生率。
本研究共纳入1143例患者。经过倾向评分匹配（PSM）后，患者的人口统计学特征无显著差异。ERAS组1年、3年的DFS高于非ERAS组（1年时分别为96.3%对88.9%，P = 0.012；3年时分别为58.9%对46.7%，P = 0.007）。ERAS组1年、3年的OS高于非ERAS组（1年时分别为93.1%对89.3%，P = 0.041；3年时分别为68.7%对61.2%，P = 0.035）。此外，ERAS组患者术后出血、胆漏及术后深静脉血栓形成/肺栓塞（DVT/PE）的发生率较低，30天再入院率和总再入院率降低，住院时间缩短。
ERAS方案可安全应用于接受肝切除的患者，从而改善其恢复情况并延长OS和DFS。
