The aim of this study was to investigate the effect of enhanced recovery after surgery (ERAS) on perioperative outcomes, with an emphasis on patient-reported outcomes (PROs) and functional recovery. We compared the clinical outcomes in a cohort of 275 patients undergoing liver resection before and after the implementation of ERAS. The PROs were preoperatively and postoperatively compared until 14 days after surgery using the MD Anderson Symptom Inventory. The patients in the ERAS group experienced fewer symptoms and a shorter functional recovery time than the patients in the non-ERAS group. The group × time interactions were different between the groups for pain (F = 4.70, P = .001) and walking (F = 2.75, P = .03). On the 3rd, 4th, and 5th days after surgery, the ERAS group experienced less pain and more walking than the non-ERAS group. The ERAS group experienced less fatigue (0.407 [95% confidence interval, CI: −0.795, −0.020], P = .035), less sleep interference (0.615 [95% CI: −1.215, −0.014], P = .045), a lower rate of reduced appetite (0.281 [95% CI: −0.442, −0.120], P = .001), and less abdominal distension (0.262 [95% CI: −0.504, −0.020], P = .034) than the non-ERAS group. Those in the ERAS group had a significantly shorter median time from surgery to mild fatigue (5.41 vs 6.87 days, P = .003), mild pain (4.45 vs 6.09 days, P = .001), mild interference when walking (3.85 vs 5.54 days, P < .001), and mild interference when sleeping (5.49 vs 7.43 days, P < .001). ERAS patients were more likely than non-ERAS patients to achieve a functional recovery (5.70 vs 6.79 days, P < .001) status in a shorter time period. The ERAS pathway, operation time, and the minimally invasive approach were independent predictors of functional recovery time. In hepatocellular carcinoma liver resection patients, the primary mechanism of ERAS is to reduce the postoperative interference burden and promote rapid functional recovery.

Background Under normal physiological conditions, insulin exhibited a series of important biological functions. However, more and more evidence indicate that insulin is closely related to the occurrence and development of tumors. Recent studies have shown that insulin is also closely related to the occurrence and development of lung cancer. However, until now, the cellular properties of insulin/insulin receptors on lung cancer have not been fully revealed. Methods Indirect immunofluorescence, western-blot and other techniques have been used to identify the biological activity of insulin on lung cancer cell lines. Results The biological activity of insulin is closely related to its cell behavior. therefore we used lung cancer cell lines as a model to explore the cellular behavior and properties of insulin/IR in the current study, and the results showed that the IR can internalize into lung cancer cells, and it can also transport into the nucleus under insulin treatment. further study showed nuclear-localized IR could promote the proliferation of lung cancer cells. Taken together, this study shows that IR’s nuclear localization is closely related to cell proliferation. Conclusions This work lays the foundation for further research on relationship between insulin and the occurrence and development of lung cancer.