Enhanced recovery programmes in hepatobiliary and pancreatic surgery: a systematic review

Abstract

INTRODUCTIONThe terms ‘enhanced recovery after surgery’, ‘enhanced recovery programme’ (ERP) and ‘fast track surgery’ refer to multimodal strategies aiming to streamline peri-operative care pathways, to maximise effectiveness and minimise costs. While the results of ERP in colorectal surgery are well reported, there have been no reviews examining if these concepts could be applied safely to hepatopancreatobiliary (HPB) surgery. The aim of this systematic review was to appraise the current evidence for ERP in HPB surgery.METHODSA MEDLINE® literature search was undertaken using the keywords ‘enhanced recovery’, ‘fast-track’, ‘peri-operative’, ‘surgery’, ‘pancreas’ and ‘liver’ and their derivatives such as ‘pancreatic’ or ‘hepatic’. The primary endpoint was length of post-operative hospital stay. Secondary endpoints were morbidity, mortality and readmission rate.RESULTSTen articles were retrieved describing an ERP. ERP protocols varied slightly between studies. A reduction in length of stay was a consistent finding following the incorporation of ERP when compared with historical controls. This was not at the expense of increased rates of readmission, morbidity or mortality in any study.CONCLUSIONSThe introduction of an ERP in HPB surgery appears safe and feasible. Currently, many of the principles of the multimodal pathway are derived from the colorectal ERP and distinct differences exist, which may impede its implementation in HPB surgery.

Fast-Track Programs for Liver Surgery: A Meta-Analysis

“…Four previous systematic reviews [42][43][44][45] have explored this theme by now; however, these previous reviews included no RCTs (Coolsen et al 45 included two RCTs that did not purely compared FT programs with CS programs-both control and experimental groups in these two RCTs were all treated with FT programs) and analyzed some case-control studies or retrospective case series studies that solely discussed the effects of FTS programs without setting a control group, this may reduce the potency of systematic review. A recent systematic review 46 contained two RCTs and published in 2014, also investigated this topic and showed more cogency than previous studies.…”

Effects of implementing an “enhanced recovery after surgery” program on patients undergoing resection of hepatocellular carcinoma

“…These programs use a multimodal approach to maximize effectiveness and minimize cost, thus optimizing perioperative care pathways [6]. ERAS programs have been associated with reduced complication rates, hospital stays, and hospital costs [1].…”

Implementation of Enhanced Recovery (ERAS) in Colorectal Surgery Has a Positive Impact on Non‐ERAS Liver Surgery Patients

“…As a result, ERAS protocols were subsequently extended to other types of surgery, including gastric 6 , pancreatic 7 and liver 8 surgery. The use of ERAS protocols in liver surgery appeared to be safe and feasible [9][10][11] .…”