Application of “LEER” mode accelerated rehabilitation surgery concept in laparoscopic anatomical hepatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIE Qingyun ¹ ,  LEI Zehua ¹ , GAO Fengwei ¹ , YANG Jie ¹ , LU Heng ² , JIANG Kangyi ¹ , GONG Jie ¹ , ZHAO Xin ¹ , XUE Qian ¹

1. Department of Hepatobiliary Pancreatic Splenic Surgery, Leshan People's Hospital of Sichuan Province, Diagnosis and Treatment Center of Hepatobiliary Pancreatic Splenic Systemic Disease in Leshan, and The Second Batch of Hepatobiliary and Pancreatic ERAS standard wards of Hubei Chen Xiaoping Science and Technology Development Foundation, Leshan, Sichuan 614000, P. R. China;
2. Department of Surgery and Anesthesia, Leshan people's Hospital, Leshan, Sichuan 614000, P. R. China;

Corresponding author：

LEI Zehua, Email: leisehua@126.com

Keywords：

“LEER” model; enhanced recovery after surgery; primary liver cancer; laparoscopy; anatomical hepatectomy

DOI：

10.7507/1007-9424.202006063

Video：

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Objective To explore the clinical value and experience of enhanced recovery after surgery (ERAS) of “LEER” model with “less pain” “early move” “early eat” and “reassuring” as its ultimate goal in perioperative period of laparoscopic anatomical hepatectomy of patients with primary liver cancer.Methods The basic clinical data of 98 patients treated in our department from May 2017 to March 2020 who were diagnosed as primary liver cancer and underwent laparoscopic anatomical hepatectomy were retrospectively analyzed. The incidence of postoperative complications, postoperative recovery and patients’ satisfaction were compared between 40 patients managed with traditional model (traditional group) and 58 patients managed with measures of ERAS of “LEER” model (“LEER”-ERAS group).Results Compared with the traditional group, the “LEER”-ERAS group had lower postoperative pain scores (t=2.925, P=0.004), earlier postoperative anal exhaustion, bowel movement and normal diet (t=3.071, t=3.770, t=3.232, all P<0.005) , shorter time to postoperative off-bed activity (t=5.025, P<0.001) and earlier postoperative removal time of drainage tube (t=3.232, P=0.001). Postoperative hospital stay was shorter (t=4.831, P<0.001), the cost of hospitalization was lower (t=3.062, P=0.003), and the patient’s satisfaction with medical treatment was higher (χ²=9.267, P=0.002). There were no statistical difference in the operative time, intraoperative blood loss, rate of conversion to laparotomy, blocking time of porta hepatis, postoperative complications and postoperative adverse events between the two groups (P>0.05).Conclusions Compared with the traditional model, the measures of ERAS of “LEER” model that applied to laparoscopic anatomical hepatectomy of patients with primary liver cancer, is safe and effective, and can relieve postoperative pain, accelerate postoperative rehabilitation, improve satisfaction of patients, shorten hospital stay, and reduce medical costs. It has further promotion and research value.

Citation： XIE Qingyun, LEI Zehua, GAO Fengwei, YANG Jie, LU Heng, JIANG Kangyi, GONG Jie, ZHAO Xin, XUE Qian. Application of “LEER” mode accelerated rehabilitation surgery concept in laparoscopic anatomical hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(3): 322-328. doi: 10.7507/1007-9424.202006063 Copy

1.	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
2.	Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr, 2005, 24(3): 466-477.
3.	Basse L, Hjort Jakobsen D, Billesbølle P, et al. A clinical pathway to accelerate recovery after colonic resection. Ann Surg, 2000, 232(1): 51-57.
4.	Melnyk M, Casey RG, Black P, et al. Enhanced recovery after surgery (ERAS) protocols: time to change practice? Can Urol Assoc J, 2011, 5(5): 342-348.
5.	黎介寿. 对Fast-track Surgery (快通道外科)内涵的认识. 中华医学杂志, 2007, 87(8): 515-517.
6.	江志伟, 黎介寿, 汪志明, 等. 胃癌患者应用加速康复外科治疗的安全性及有效性研究. 中华外科杂志, 2007, 45(19): 1314-1317.
7.	江志伟, 黎介寿, 汪志明, 等. 加速康复外科用于直肠癌前切除病人价值探讨. 中国实用外科杂志, 2008, 28(1): 59-61.
8.	黎介寿, 江志伟. 加速康复外科的临床意义不仅仅是缩短住院日. 中华消化外科杂志, 2015, 14(1): 22-24.
9.	Varadhan KK, Neal KR, Dejong CH, et al. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr, 2010, 29(4): 434-440.
10.	童卫东. 结直肠外科围手术期处理的革命性进展—加速康复外科理念. 国际外科学杂志, 2011, 38(8): 508-510.
11.	陈孝平. “两减一保” —中国医生早年对病人加速康复的认识与实践. 腹部外科, 2017, 30(2): 73-74.
12.	陈凛, 陈亚进, 董海龙, 等. 加速康复外科中国专家共识及路径管理指南(2018版). 中国实用外科杂志, 2018, 38(1): 1-20.
13.	Abeles A, Kwasnicki RM, Darzi A. Enhanced recovery after surgery: Current research insights and future direction. World J Gastrointest Surg, 2017, 9(2): 37-45.
14.	雷泽华, 谢青云, 赵欣, 等. “LEER”模式加速康复外科理念在胰十二指肠切除术中的应用. 肝胆胰外科杂志, 2020, 32(3): 138-142.
15.	van Dam RM, Hendry PO, Coolsen MM, et al. Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection. Br J Surg, 2008, 95(8): 969-975.
16.	Koea JB, Young Y, Gunn K. Fast track liver resection: the effect of a comprehensive care package and analgesia with single dose intrathecal morphine with gabapentin or continuous epidural analgesia. HPB Surg, 2009, 2009: 271986.
17.	Savikko J, Ilmakunnas M, Mäkisalo H, et al. Enhanced recovery protocol after liver resection. Br J Surg, 2015, 102(12): 1526-1532.
18.	Qi S, Chen G, Cao P, et al. Safety and efficacy of enhanced recovery after surgery (ERAS) programs in patients undergoing hepatectomy: a prospective randomized controlled trial. J Clin Lab Anal, 2018, 32(6): e22434.
19.	Zhao Y, Qin H, Wu Y, et al. Enhanced recovery after surgery program reduces length of hospital stay and complications in liver resection: a PRISMA-compliant systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore), 2017, 96(31): e7628.
20.	韩冰, 丁义涛, 朱新华, 等. 加速康复外科理念在腹腔镜肝切除术中的应用. 临床肝胆病杂志, 2018, (3): 567-572.
21.	骆鹏飞, 荚卫东, 许戈良, 等. 加速康复外科理念在原发性肝癌患者肝切除围手术期中的应用. 中华普通外科杂志, 2015, 30(11): 862-865.
22.	Sánchez-Pérez B, Aranda-Narváez JM, Suárez-Muñoz MA, et al. Fast-track program in laparoscopic liver surgery: Theory or fact? World J Gastrointest Surg, 2012, 4(11): 246-250.
23.	朱斌, 黄建宏. 加速康复外科在我国发展现状、挑战与对策. 中国实用外科杂志, 2017, 37(1): 26-27.
24.	Visioni A, Shah R, Gabriel E, et al. Enhanced recovery after surgery for noncolorectal surgery?: a systematic review and meta-analysis of major abdominal surgery. Ann Surg, 2018, 267(1): 57-65.
25.	姜洪池, 李丹. 实施加速康复外科若干问题思考. 中国实用外科杂志, 2017, 37(1): 1-4.
26.	Sibbern T, Bull Sellevold V, Steindal SA, et al. Patients' experiences of enhanced recovery after surgery: a systematic review of qualitative studies. J Clin Nurs, 2017, 26(9-10): 1172-1188.
27.	Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg, 2017, 152(3): 292-298.
28.	英卫东. 加速康复外科多学科团队建设. 中华外科杂志, 2018, 56(1): 14-17.

1. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
2. Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr, 2005, 24(3): 466-477.
3. Basse L, Hjort Jakobsen D, Billesbølle P, et al. A clinical pathway to accelerate recovery after colonic resection. Ann Surg, 2000, 232(1): 51-57.
4. Melnyk M, Casey RG, Black P, et al. Enhanced recovery after surgery (ERAS) protocols: time to change practice? Can Urol Assoc J, 2011, 5(5): 342-348.
5. 黎介寿. 对Fast-track Surgery (快通道外科)内涵的认识. 中华医学杂志, 2007, 87(8): 515-517.
6. 江志伟, 黎介寿, 汪志明, 等. 胃癌患者应用加速康复外科治疗的安全性及有效性研究. 中华外科杂志, 2007, 45(19): 1314-1317.
7. 江志伟, 黎介寿, 汪志明, 等. 加速康复外科用于直肠癌前切除病人价值探讨. 中国实用外科杂志, 2008, 28(1): 59-61.
8. 黎介寿, 江志伟. 加速康复外科的临床意义不仅仅是缩短住院日. 中华消化外科杂志, 2015, 14(1): 22-24.
9. Varadhan KK, Neal KR, Dejong CH, et al. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr, 2010, 29(4): 434-440.
10. 童卫东. 结直肠外科围手术期处理的革命性进展—加速康复外科理念. 国际外科学杂志, 2011, 38(8): 508-510.
11. 陈孝平. “两减一保” —中国医生早年对病人加速康复的认识与实践. 腹部外科, 2017, 30(2): 73-74.
12. 陈凛, 陈亚进, 董海龙, 等. 加速康复外科中国专家共识及路径管理指南(2018版). 中国实用外科杂志, 2018, 38(1): 1-20.
13. Abeles A, Kwasnicki RM, Darzi A. Enhanced recovery after surgery: Current research insights and future direction. World J Gastrointest Surg, 2017, 9(2): 37-45.
14. 雷泽华, 谢青云, 赵欣, 等. “LEER”模式加速康复外科理念在胰十二指肠切除术中的应用. 肝胆胰外科杂志, 2020, 32(3): 138-142.
15. van Dam RM, Hendry PO, Coolsen MM, et al. Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection. Br J Surg, 2008, 95(8): 969-975.
16. Koea JB, Young Y, Gunn K. Fast track liver resection: the effect of a comprehensive care package and analgesia with single dose intrathecal morphine with gabapentin or continuous epidural analgesia. HPB Surg, 2009, 2009: 271986.
17. Savikko J, Ilmakunnas M, Mäkisalo H, et al. Enhanced recovery protocol after liver resection. Br J Surg, 2015, 102(12): 1526-1532.
18. Qi S, Chen G, Cao P, et al. Safety and efficacy of enhanced recovery after surgery (ERAS) programs in patients undergoing hepatectomy: a prospective randomized controlled trial. J Clin Lab Anal, 2018, 32(6): e22434.
19. Zhao Y, Qin H, Wu Y, et al. Enhanced recovery after surgery program reduces length of hospital stay and complications in liver resection: a PRISMA-compliant systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore), 2017, 96(31): e7628.
20. 韩冰, 丁义涛, 朱新华, 等. 加速康复外科理念在腹腔镜肝切除术中的应用. 临床肝胆病杂志, 2018, (3): 567-572.
21. 骆鹏飞, 荚卫东, 许戈良, 等. 加速康复外科理念在原发性肝癌患者肝切除围手术期中的应用. 中华普通外科杂志, 2015, 30(11): 862-865.
22. Sánchez-Pérez B, Aranda-Narváez JM, Suárez-Muñoz MA, et al. Fast-track program in laparoscopic liver surgery: Theory or fact? World J Gastrointest Surg, 2012, 4(11): 246-250.
23. 朱斌, 黄建宏. 加速康复外科在我国发展现状、挑战与对策. 中国实用外科杂志, 2017, 37(1): 26-27.
24. Visioni A, Shah R, Gabriel E, et al. Enhanced recovery after surgery for noncolorectal surgery?: a systematic review and meta-analysis of major abdominal surgery. Ann Surg, 2018, 267(1): 57-65.
25. 姜洪池, 李丹. 实施加速康复外科若干问题思考. 中国实用外科杂志, 2017, 37(1): 1-4.
26. Sibbern T, Bull Sellevold V, Steindal SA, et al. Patients' experiences of enhanced recovery after surgery: a systematic review of qualitative studies. J Clin Nurs, 2017, 26(9-10): 1172-1188.
27. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg, 2017, 152(3): 292-298.
28. 英卫东. 加速康复外科多学科团队建设. 中华外科杂志, 2018, 56(1): 14-17.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of “LEER” mode accelerated rehabilitation surgery concept in laparoscopic anatomical hepatectomy

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