Application Value of ERAS in Perioperative Period of Precise Hepatectomy for Hepatocellular Carcinoma Patients

J BUON. Mar-Apr 2020;25(2):965-971.

Abstract

Purpose: To explore the efficacy and reliability of enhanced recovery after surgery (ERAS) applied in the perioperative period of precise hepatectomy for hepatocellular carcinoma (HCC).

Methods: The propensity score matching and a retrospective cohort study were employed. The clinical and pathological data of 122 hepatocellular carcinoma (HCC) patients with surgical indications admitted to our hospital from March 2014 to March 2016 were collected. These 122 patients were subjected to propensity score matching and divided into ERAS group and Control group. The surgical situation, postoperative recovery [postoperative alanine aminotransferase (ALT), total bilirubin (TBiL) and C-reactive protein (CRP) levels], postoperative complications, postoperative hospital stay, hospitalization costs and patient satisfaction score were observed and compared between the two groups. All patients were followed up to record their postoperative survival.

Results: The average drainage tube removal time, bowel sound time, postoperative flatus time and postoperative hospital stay of patients were overtly shorter in ERAS group than in Control group. Besides, the postoperative numerical rating scale (NRS) score and the incidence rate of moderate and severe pain after surgery were lower in ERAS group than in Control group. The total hospitalization cost was significantly lower in ERAS group than in Control group. The patient satisfaction score was obviously higher in ERAS group than in Control group. ERAS group had fewer cases of postoperative vomiting, abdominal distension, biliary fistula, intestinal obstruction, large-volume ascites, liver failure, wound infection, pulmonary infection and abdominal infection than Control group, but the differences were not statistically significant. The ALT, TBiL and CRP levels of patients were notably lower in ERAS group than in Control group at d 7 after surgery. Based on the follow-up results, there was no significant difference in overall survival between the two groups.

Conclusion: ERAS applied in the perioperative period of HCC patients receiving precise hepatectomy is reliable and effective and has positive significance for the promotion of postoperative rehabilitation, which is worthy of popularization in clinical practice.