Effect of enhanced recovery after surgery protocol on recovery after open hepatectomy: a randomized clinical trial

Wataru Nakanishi; Shigehito Miyagi; Kazuaki Tokodai; Atsushi Fujio; Kengo Sasaki; Yoshihiro Shono; Michiaki Unno; Takashi Kamei

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자료유형: 학술저널

저자정보: Wataru Nakanishi (Tohoku University Graduate School of Medicine) Shigehito Miyagi (Tohoku University Graduate School of Medicine) Kazuaki Tokodai (Tohoku University Graduate School of Medicine) Atsushi Fujio (Tohoku University Graduate School of Medicine) Kengo Sasaki (Tohoku University Graduate School of Medicine) Yoshihiro Shono (Tohoku University Graduate School of Medicine) Michiaki Unno (Tohoku University Graduate School of Medicine) Takashi Kamei (Tohoku University Graduate School of Medicine)

저널정보: 대한외과학회 Annals of Surgical Treatment and Research Annals of Surgical Treatment and Research Vol.99 No.6

발행연도: 2020.12

수록면: 320 - 328 (9page)

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Purpose: Enhanced recovery after surgery (ERAS) is beneficial to patients undergoing digestive surgery. However, its efficacy in patients undergoing open hepatectomy remains unclear.
Methods: Consecutive patients scheduled for open hepatectomy were randomly assigned to undergo either ERAS or conventional postoperative management. The primary endpoint was the amount of time that elapsed before patients were considered medically fit for discharge (MFD) and length of hospital stay (LOHS). Secondary endpoints included morbidity, mortality, the time to first flatus, defecation, first walk, and freedom from infusion. Perioperative serum nutritional markers, insulin resistance, respiratory quotient (RQ), and resting energy expenditure (REE) were also assessed.
Results: Between August 2014 and March 2017, 57 patients were randomized into 2 groups; ERAS group (n = 29) and conventional management (n = 28). The median MFD was not significantly different between the ERAS and conventional management groups (6.5 vs. 7 days; P = 0.381). Recovery from gastrointestinal paresis was significantly quicker in the ERAS group (1.8 vs. 2.4 days; P = 0.004). There were no significant differences in serum markers, insulin resistance, RQ, and REE.
Conclusion: This trial did not demonstrate greater efficacy of the ERAS protocol following open hepatectomy in terms of the MFD and LOHS. However, the ERAS protocol was associated with better recovery from postoperative gastrointestinal paresis, suggesting that it is useful for patients undergoing open hepatectomy.

#Enhanced recovery after surgery #Hepatectomy #Perioperative treatments #Randomized controlled trial

참고문헌 (27)

참고문헌 신청

Lassen K / 2012 / Guidelines for perioperative care for pancreaticoduodenectomy : Enhanced Recovery After Surgery(ERAS®)Society recommendations / Clin Nutr 31:817~830

Martin D / 2018 / A multicentre qualitative study assessing implementation of an Enhanced Recovery After Surgery program / Clin Nutr 37:2172~2177

Lv L / 2012 / The enhanced recovery after surgery(ERAS)pathway for patients undergoing colorectal surgery : an update of meta-analysis of randomized controlled trials / Int J Colorectal Dis 27:1549~1554

Ota H / 2017 / Safety and efficacy of an “enhanced recovery after surgery” protocol for patients undergoing colon cancer surgery: a multi-institutional controlled study / Surg Today 47:668~675

Wei AC / 2006 / Sur vival after hepatic resection for colorectal metastases : a 10-year experience / Ann Surg Oncol 13:668~676

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