Milivojev Covilo Kristina, Pagano Stella J, Ross Sharona B, Bilik Alona, Vanterpool Garnet, Sucandy Iswanto
Director of Hepatobiliary and Robotic Liver Surgery Program, Codirector of Advanced Gastrointestinal and Hepatopancreatobiliary Fellowship, Division Chief of Hepatopancreatobiliary Surgery, Digestive Health Institute of AdventHealth Tampa, Hepatopancreatobiliary (HPB) and Robotic Surgery, 3000 Medical Park Drive, Suite # 500, Tampa, FL, 33613, USA.
Updates Surg. 2025 Sep 19. doi: 10.1007/s13304-025-02399-4.
Since its development, Enhanced Recovery After Surgery (ERAS) protocol has generally improved patient outcomes and enhanced peri-operational organization. The protocol includes less intraoperative invasiveness and enhances perioperative mobility and nutrition. Robotic technology has demonstrated similar benefits, particularly in complex hepatobiliary resections. This study describes comparative outcomes of robotic hepatectomy before and after ERAS protocol implementation in our program. With Institutional Review Board (IRB) approval, 609 patients who underwent robotic liver resection between 2013 and 2024 were retrospectively analyzed. A total of the first 65 patients were excluded to eliminate the impact of a learning curve. The remaining 544 patients were divided into 2 groups based on ERAS protocol use. Propensity score matching 1:2 was applied according to age, BMI, tumor size, tumor type, and extent of liver resection. Perioperative outcomes of pre-ERAS and post-ERAS groups were compared. Patients in the post-ERAS group more frequently had coronary artery disease (5.7% vs. 10.6%) and hypertension (5.7% vs 57%), whereas patients in the pre-ERAS group more frequently had heart disease (46.2% vs 11.1%). Estimated blood loss (EBL) decreased (214.7(150.0) ± 250.9 vs. 141.7(100.0) ± 151.5) in the post-ERAS group. A decrease in 90-day readmission rate was also observed in the post-ERAS group (22.6% vs. 13.4%). A propensity score-matched comparison of robotic hepatectomy outcomes before and after ERAS protocol showed improvement in perioperative outcomes, with lower estimated blood loss and fewer 90-day readmissions.
自其发展以来，术后加速康复（ERAS）方案总体上改善了患者预后并优化了围手术期管理。该方案包括减少术中侵袭性，并增强围手术期的活动能力和营养状况。机器人技术也显示出类似的益处，尤其是在复杂的肝胆切除术中。本研究描述了在我们的项目中实施ERAS方案前后机器人肝切除术的对比结果。经机构审查委员会（IRB）批准，对2013年至2024年间接受机器人肝脏切除术的609例患者进行了回顾性分析。总共排除了前65例患者以消除学习曲线的影响。其余544例患者根据是否使用ERAS方案分为两组。根据年龄、体重指数、肿瘤大小、肿瘤类型和肝切除范围进行倾向得分匹配1:2。比较了ERAS前组和ERAS后组的围手术期结果。ERAS后组患者冠心病（5.7%对10.6%）和高血压（5.7%对57%）的发生率更高，而ERAS前组患者心脏病（46.2%对11.1%）的发生率更高。ERAS后组的估计失血量（EBL）减少（214.7(150.0)±250.9对141.7(100.0)±151.5）。ERAS后组90天再入院率也有所下降（22.6%对13.4%）。ERAS方案前后机器人肝切除术结果的倾向得分匹配比较显示围手术期结果有所改善，估计失血量更低，90天再入院次数更少。
