Impact of ERAS approach and minimally-invasive techniques on outcome of patients undergoing liver surgery for hepatocellular carcinoma

Francesca Ratti, Federica Cipriani, Raffaella Reineke, Marco Catena, Laura Comotti, Luigi Beretta, Luca Aldrighetti

Research output: Contribution to journalArticle

Abstract

Background and aim Aim of the study was to assess the impact of ERAS approach (“fluid restrictive and drainless”) on open liver resections for HCC comparing their outcome with open resections in pre-ERAS period and with laparoscopic surgery. Study design 207 patients undergoing minor liver resection for HCC were divided into three groups: Group A, open minor resections in pre-ERAS period (95 patients); Group B, laparoscopic ERAS resections (55 patients); Group C, open ERAS resections (57 patients). Results Blood loss was lower in group C and B compared with group A. Postoperative morbidity was 26.5% in group A, 16.3% in group B and 12.1% in group C (p <0.05). Ascites was less frequent in group B (7.5%) and C (6.2%) compared with group A (12%). Median time for functional recovery in group B (3 days) and C (3 days) was shorter compared with group A (5 days). Conclusions Laparoscopic approach confirms to be associated with reduced blood loss and postoperative morbidity. In patients who cannot be candidates to minimally-invasive approach, ERAS management seems to allow blood loss and postoperative morbidity reduction: indeed, results achieved in this group of patients are more similar to those of laparoscopy than to pre-ERAS open surgery.
Original languageEnglish
Pages (from-to)1243 - 1248
Number of pages6
JournalDigestive and Liver Disease
Volume48
Issue number10
DOIs
Publication statusPublished - Oct 1 2016

Fingerprint

Hepatocellular Carcinoma
Liver
Postoperative Hemorrhage
Morbidity
Laparoscopy
Ascites

Keywords

  • ERAS
  • Fast track
  • Hepatocellular carcinoma
  • Laparoscopy
  • Liver failure
  • Liver surgery

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Impact of ERAS approach and minimally-invasive techniques on outcome of patients undergoing liver surgery for hepatocellular carcinoma. / Ratti, Francesca; Cipriani, Federica; Reineke, Raffaella; Catena, Marco; Comotti, Laura; Beretta, Luigi; Aldrighetti, Luca.

In: Digestive and Liver Disease, Vol. 48, No. 10, 01.10.2016, p. 1243 - 1248.

Research output: Contribution to journalArticle

Ratti, Francesca ; Cipriani, Federica ; Reineke, Raffaella ; Catena, Marco ; Comotti, Laura ; Beretta, Luigi ; Aldrighetti, Luca. / Impact of ERAS approach and minimally-invasive techniques on outcome of patients undergoing liver surgery for hepatocellular carcinoma. In: Digestive and Liver Disease. 2016 ; Vol. 48, No. 10. pp. 1243 - 1248.
@article{6a0f376f8b8e4c6b89b8adcce9eb9ac3,
title = "Impact of ERAS approach and minimally-invasive techniques on outcome of patients undergoing liver surgery for hepatocellular carcinoma",
abstract = "Background and aim Aim of the study was to assess the impact of ERAS approach (“fluid restrictive and drainless”) on open liver resections for HCC comparing their outcome with open resections in pre-ERAS period and with laparoscopic surgery. Study design 207 patients undergoing minor liver resection for HCC were divided into three groups: Group A, open minor resections in pre-ERAS period (95 patients); Group B, laparoscopic ERAS resections (55 patients); Group C, open ERAS resections (57 patients). Results Blood loss was lower in group C and B compared with group A. Postoperative morbidity was 26.5{\%} in group A, 16.3{\%} in group B and 12.1{\%} in group C (p <0.05). Ascites was less frequent in group B (7.5{\%}) and C (6.2{\%}) compared with group A (12{\%}). Median time for functional recovery in group B (3 days) and C (3 days) was shorter compared with group A (5 days). Conclusions Laparoscopic approach confirms to be associated with reduced blood loss and postoperative morbidity. In patients who cannot be candidates to minimally-invasive approach, ERAS management seems to allow blood loss and postoperative morbidity reduction: indeed, results achieved in this group of patients are more similar to those of laparoscopy than to pre-ERAS open surgery.",
keywords = "ERAS, Fast track, Hepatocellular carcinoma, Laparoscopy, Liver failure, Liver surgery",
author = "Francesca Ratti and Federica Cipriani and Raffaella Reineke and Marco Catena and Laura Comotti and Luigi Beretta and Luca Aldrighetti",
year = "2016",
month = "10",
day = "1",
doi = "10.1016/j.dld.2016.06.032",
language = "English",
volume = "48",
pages = "1243 -- 1248",
journal = "Digestive and Liver Disease",
issn = "1590-8658",
publisher = "Elsevier B.V.",
number = "10",

}

TY - JOUR

T1 - Impact of ERAS approach and minimally-invasive techniques on outcome of patients undergoing liver surgery for hepatocellular carcinoma

AU - Ratti, Francesca

AU - Cipriani, Federica

AU - Reineke, Raffaella

AU - Catena, Marco

AU - Comotti, Laura

AU - Beretta, Luigi

AU - Aldrighetti, Luca

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background and aim Aim of the study was to assess the impact of ERAS approach (“fluid restrictive and drainless”) on open liver resections for HCC comparing their outcome with open resections in pre-ERAS period and with laparoscopic surgery. Study design 207 patients undergoing minor liver resection for HCC were divided into three groups: Group A, open minor resections in pre-ERAS period (95 patients); Group B, laparoscopic ERAS resections (55 patients); Group C, open ERAS resections (57 patients). Results Blood loss was lower in group C and B compared with group A. Postoperative morbidity was 26.5% in group A, 16.3% in group B and 12.1% in group C (p <0.05). Ascites was less frequent in group B (7.5%) and C (6.2%) compared with group A (12%). Median time for functional recovery in group B (3 days) and C (3 days) was shorter compared with group A (5 days). Conclusions Laparoscopic approach confirms to be associated with reduced blood loss and postoperative morbidity. In patients who cannot be candidates to minimally-invasive approach, ERAS management seems to allow blood loss and postoperative morbidity reduction: indeed, results achieved in this group of patients are more similar to those of laparoscopy than to pre-ERAS open surgery.

AB - Background and aim Aim of the study was to assess the impact of ERAS approach (“fluid restrictive and drainless”) on open liver resections for HCC comparing their outcome with open resections in pre-ERAS period and with laparoscopic surgery. Study design 207 patients undergoing minor liver resection for HCC were divided into three groups: Group A, open minor resections in pre-ERAS period (95 patients); Group B, laparoscopic ERAS resections (55 patients); Group C, open ERAS resections (57 patients). Results Blood loss was lower in group C and B compared with group A. Postoperative morbidity was 26.5% in group A, 16.3% in group B and 12.1% in group C (p <0.05). Ascites was less frequent in group B (7.5%) and C (6.2%) compared with group A (12%). Median time for functional recovery in group B (3 days) and C (3 days) was shorter compared with group A (5 days). Conclusions Laparoscopic approach confirms to be associated with reduced blood loss and postoperative morbidity. In patients who cannot be candidates to minimally-invasive approach, ERAS management seems to allow blood loss and postoperative morbidity reduction: indeed, results achieved in this group of patients are more similar to those of laparoscopy than to pre-ERAS open surgery.

KW - ERAS

KW - Fast track

KW - Hepatocellular carcinoma

KW - Laparoscopy

KW - Liver failure

KW - Liver surgery

UR - http://www.scopus.com/inward/record.url?scp=84981744776&amp;partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84981744776&amp;partnerID=8YFLogxK

U2 - 10.1016/j.dld.2016.06.032

DO - 10.1016/j.dld.2016.06.032

M3 - Article

VL - 48

SP - 1243

EP - 1248

JO - Digestive and Liver Disease

JF - Digestive and Liver Disease

SN - 1590-8658

IS - 10

ER -