The application of modified fast-track surgery in the perioperative period of open partial hepatectomy_West China Medical Journal

Authors：

REN Qiuping , YANG Jian ,  LUO Yanli

Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LUO Yanli, Email: luoyl6@126.com

Keywords：

Fast-track surgery; Open liver resection; Length of hospital stay; Multimodal analgesia

DOI：

10.7507/1002-0179.201510101

Video：

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Objective To verify the feasibility and effectiveness of the modified fast-track surgery (FTS) in the perioperative period of open liver resection. Methods A prospective randomized controlled trial was carried out in 188 consecutive patients undergoing open liver resection between March and December 2014 in the Department of Liver Surgery of West China Hospital. The modified fast recovery procedure and standard rehabilitation procedure were compared in terms of length of hospital stay after operation, hospitalization cost, complications and readmission rate. Results A total of 188 consecutive patients were enrolled in the trial. The analysis included 87 patients in the modified fast recovery group and 89 in the standard rehabilitation group. Compared with the standard rehabilitation group, the modified fast recovery group had a shorter length of hospital stay [(5.70±1.47)vs. (7.26±1.96) days] and a lower cost [(42.7±6.7)vs. (47.3±12.5) thousand yuan], and the differences were statistically significant (P<0.05). There were 20 complication cases in the modified group and 39 in the standard group with significant difference (P=0.003). There was no significant difference in the rate of readmission between the two groups (P=1.000). Compared with the standard group, patients in the modified group had less pain 8 hours, the 1st and 2nd days after surgery, better postoperative activities of daily living, more initiative cough times and off-bed activity times, longer duration of movement, and earlier bowel recovery and exhausting, and all the above differences were significantly different (P<0.05). Stepwise regression analysis showed that postoperative complications and bowel recovery and exhausting time were independent related factors for postoperative hospital stay (P<0.001). Conclusions Multimodal analgesia-based fast recovery procedure is feasible and effective in the perioperative period of partial hepatectomy. It can shorten the time of hospitalization and reduce the cost of hospitalization.

Citation： REN Qiuping, YANG Jian, LUO Yanli. The application of modified fast-track surgery in the perioperative period of open partial hepatectomy. West China Medical Journal, 2017, 32(5): 717-722. doi: 10.7507/1002-0179.201510101 Copy

1.	Nguyen KT, Marsh JW, Tsung A, et al. Comparative benefits of laparoscopicvs open hepatic resection a critical appraisal. Arch Surg, 2011, 146(3): 348-356.
2.	Kehlet H, Slim K. The future of fast-track surgery. Br J Surg, 2012, 99(8): 1025-1026.
3.	Miller TE, Thacker JK, White WD, et al. Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg, 2014, 118(5): 1052-1061.
4.	Mertz BG, Kroman N, Williams H, et al. Fast-track surgery for breast cancer is possible. Dan Med J, 2013, 60(5): A4615.
5.	Hughes MJ, Mcnally S, Wigmore SJ. Enhanced recovery following liver surgery: a systematic review and meta-analysis. HPB (Oxford), 2014, 16(8): 699-706.
6.	Wong-Lun-Hing EM, van Dam RM, Heijnen LA, et al. Is current perioperative practice in hepatic surgery based on enhanced recovery after surgery (ERAS) principles?. World J Surg 2014, 38(5): 1127-1140.
7.	Stoot JH, van Dam RM, Busch OR, et al. The effect of a multimodal fast-track programme on outcomes in laparoscopic liver surgery: a multicentre pilot study. HPB (Oxford), 2009, 11(2): 140-144.
8.	Formiga F, Mascaró J, Pujol R. Inter-rater reliability of the Barthel Index. Age Ageing, 2005, 34(6): 655-656.
9.	Thiele RH, Rea KM, Turrentine FE, et al. Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg, 2015, 220(4): 430-443.
10.	Spelt L, Ansari D, Sturesson C, et al. Fast-track programmes for hepatopancreatic resections: where do we stand?. HPB (Oxford), 2011, 2011, 13(12): 1477-2574.
11.	Connor S, Cross A, Sakowska M, et al. Effects of introducing an enhanced recovery after surgery programme for patients undergoing open hepatic resection. HPB (Oxford), 2013, 15(4): 294-301.
12.	Ni C, Yang Y, Chang Y, et al. (2013) Fast-track surgery improves postoperative recovery in patients undergoing partial hepatectomy for primary liver cancer: a prospective randomized controlled trial. Eur J Surg Oncol, 2013, 39(6): 542-547.
13.	Jones C, Kelliher L, Dickinson M, et al. Randomized clinical trial on enhanced recoveryversus standard care following open liver resection. Br J Surg, 2013, 100(8): 1015-1024.
14.	Vivarelli M, Zanello M, Zanfi C, et al. Prophylaxis for venous thromboembolism after resection of hepatocellular carcinoma on cirrhosis: is it necessary?. World J Gastroenterol, 2010, 16(17): 2146-2150.
15.	Senzolo M, Sartori MT, Lisman T. Should we give thromboprophylaxis to patients with liver cirrhosis and coagulopathy?. HPB (Oxford), 2009, 11(6): 459-464.
16.	Schultz NA, Larsen PN, Klarskov B, et al. Evaluation of a fast-track programme for patients undergoing liver resection. Br J Surg, 2013, 100(1): 138-143.
17.	Barbas AS, Turley RS, Mallipeddi MK, et al. Examining reoperation and readmission after hepatic surgery. J Am Coll Surg, 2013, 216(5): 915-923.
18.	Thornton PC, Buggy DJ. Local anaesthetic wound infusion for acute postoperative pain: a viable option?. Br J Anaesth, 2011, 107(5): 656-658.
19.	Tzimas P, Prout J, Papadopolous G, et al. Epidural anaesthesia and analgesia for liver resection. Anaesthesia, 2013, 68(6): 628-635.
20.	van Dam RM, Wong-Lun-Hing EM, van Breukelen GJ, et al. Openversus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery ERAS® programme (ORANGE Ⅱ-trial): study protocol for a randomised controlled trial. Trial, 2012, 13: 54.
21.	van Dam RM, Wong-Lun-Hing EM, van Breukelen GJ, et al. Openversus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery ERAS®programme (ORANGE Ⅱ-trial): study protocol for a randomised controlled trial, 2012: 54.
22.	Guo YJ, Shi XD, Fu D, et al. Analgesic effects of the COX-2 inhibitor parecoxib on surgical pain through suppression of spinal ERK signaling. Exp Ther Med, 2013, 6(1): 275-279.
23.	Mackay G, O’Dwyer PJ. Early discharge following liver resection for colorectal metastases. Scott Med J, 2008, 53(2): 22-24.
24.	American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology, 2011, 114(3): 495-511.
25.	Lidder P, Thomas S, Fleming S, et al. A randomized placebo controlled trial of preoperative carbohydrate drinks and early postoperative nutritional supplement drinks in colorectal surgery. Colorectal Dis, 2013, 15(6): 737-745.
26.	Hendry PO, van Dam RM, Bukkems SF, et al. Randomized clinical trial of laxatives and oral nutritional supplements within an enhanced recovery after surgery protocol following liver resection. Br J Surg, 2010, 97(8): 1198-1206.
27.	Hughes M, Coolsen MM, Aahlin EK, et al. Attitudes of patients and care providers to enhanced recovery after surgery programs after major abdominal surgery. J Surg Res, 2015, 193(1): 102-110.
28.	Jiang L, Yang KH, Guan QL, et al. Laparoscopy-assisted gastrectomyversus open gastrectomy for resectable gastric cancer: an update meta-analysis based on randomized controlled trials. Surg Endosc, 2013, 27(7): 2466-2480.

1. Nguyen KT, Marsh JW, Tsung A, et al. Comparative benefits of laparoscopicvs open hepatic resection a critical appraisal. Arch Surg, 2011, 146(3): 348-356.
2. Kehlet H, Slim K. The future of fast-track surgery. Br J Surg, 2012, 99(8): 1025-1026.
3. Miller TE, Thacker JK, White WD, et al. Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg, 2014, 118(5): 1052-1061.
4. Mertz BG, Kroman N, Williams H, et al. Fast-track surgery for breast cancer is possible. Dan Med J, 2013, 60(5): A4615.
5. Hughes MJ, Mcnally S, Wigmore SJ. Enhanced recovery following liver surgery: a systematic review and meta-analysis. HPB (Oxford), 2014, 16(8): 699-706.
6. Wong-Lun-Hing EM, van Dam RM, Heijnen LA, et al. Is current perioperative practice in hepatic surgery based on enhanced recovery after surgery (ERAS) principles?. World J Surg 2014, 38(5): 1127-1140.
7. Stoot JH, van Dam RM, Busch OR, et al. The effect of a multimodal fast-track programme on outcomes in laparoscopic liver surgery: a multicentre pilot study. HPB (Oxford), 2009, 11(2): 140-144.
8. Formiga F, Mascaró J, Pujol R. Inter-rater reliability of the Barthel Index. Age Ageing, 2005, 34(6): 655-656.
9. Thiele RH, Rea KM, Turrentine FE, et al. Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg, 2015, 220(4): 430-443.
10. Spelt L, Ansari D, Sturesson C, et al. Fast-track programmes for hepatopancreatic resections: where do we stand?. HPB (Oxford), 2011, 2011, 13(12): 1477-2574.
11. Connor S, Cross A, Sakowska M, et al. Effects of introducing an enhanced recovery after surgery programme for patients undergoing open hepatic resection. HPB (Oxford), 2013, 15(4): 294-301.
12. Ni C, Yang Y, Chang Y, et al. (2013) Fast-track surgery improves postoperative recovery in patients undergoing partial hepatectomy for primary liver cancer: a prospective randomized controlled trial. Eur J Surg Oncol, 2013, 39(6): 542-547.
13. Jones C, Kelliher L, Dickinson M, et al. Randomized clinical trial on enhanced recoveryversus standard care following open liver resection. Br J Surg, 2013, 100(8): 1015-1024.
14. Vivarelli M, Zanello M, Zanfi C, et al. Prophylaxis for venous thromboembolism after resection of hepatocellular carcinoma on cirrhosis: is it necessary?. World J Gastroenterol, 2010, 16(17): 2146-2150.
15. Senzolo M, Sartori MT, Lisman T. Should we give thromboprophylaxis to patients with liver cirrhosis and coagulopathy?. HPB (Oxford), 2009, 11(6): 459-464.
16. Schultz NA, Larsen PN, Klarskov B, et al. Evaluation of a fast-track programme for patients undergoing liver resection. Br J Surg, 2013, 100(1): 138-143.
17. Barbas AS, Turley RS, Mallipeddi MK, et al. Examining reoperation and readmission after hepatic surgery. J Am Coll Surg, 2013, 216(5): 915-923.
18. Thornton PC, Buggy DJ. Local anaesthetic wound infusion for acute postoperative pain: a viable option?. Br J Anaesth, 2011, 107(5): 656-658.
19. Tzimas P, Prout J, Papadopolous G, et al. Epidural anaesthesia and analgesia for liver resection. Anaesthesia, 2013, 68(6): 628-635.
20. van Dam RM, Wong-Lun-Hing EM, van Breukelen GJ, et al. Openversus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery ERAS® programme (ORANGE Ⅱ-trial): study protocol for a randomised controlled trial. Trial, 2012, 13: 54.
21. van Dam RM, Wong-Lun-Hing EM, van Breukelen GJ, et al. Openversus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery ERAS®programme (ORANGE Ⅱ-trial): study protocol for a randomised controlled trial, 2012: 54.
22. Guo YJ, Shi XD, Fu D, et al. Analgesic effects of the COX-2 inhibitor parecoxib on surgical pain through suppression of spinal ERK signaling. Exp Ther Med, 2013, 6(1): 275-279.
23. Mackay G, O’Dwyer PJ. Early discharge following liver resection for colorectal metastases. Scott Med J, 2008, 53(2): 22-24.
24. American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology, 2011, 114(3): 495-511.
25. Lidder P, Thomas S, Fleming S, et al. A randomized placebo controlled trial of preoperative carbohydrate drinks and early postoperative nutritional supplement drinks in colorectal surgery. Colorectal Dis, 2013, 15(6): 737-745.
26. Hendry PO, van Dam RM, Bukkems SF, et al. Randomized clinical trial of laxatives and oral nutritional supplements within an enhanced recovery after surgery protocol following liver resection. Br J Surg, 2010, 97(8): 1198-1206.
27. Hughes M, Coolsen MM, Aahlin EK, et al. Attitudes of patients and care providers to enhanced recovery after surgery programs after major abdominal surgery. J Surg Res, 2015, 193(1): 102-110.
28. Jiang L, Yang KH, Guan QL, et al. Laparoscopy-assisted gastrectomyversus open gastrectomy for resectable gastric cancer: an update meta-analysis based on randomized controlled trials. Surg Endosc, 2013, 27(7): 2466-2480.

West China Medical Journal

The application of modified fast-track surgery in the perioperative period of open partial hepatectomy

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