Application Of Enhanced Recovery After Surgery Hepatocellular Carcinoma Cancer Hepatectomy

Purpose: to investigate the feasibility,effectiveness and safety of the enhanced recovery after surgery(ERAS)in the perioperative management of liver cancer patients after hepatectomy.Methods: two hundred and forty-four cases of liver resection patients were selected.All the patients were divided into the ERAS group(120 patients)and the control group(120 patients).The perioperative management of patients in the ERAS group was guided by the ERAS principles,while patients in the control group were managed with traditional methods.The preoperative general information,liver function,time for postoperative anal exhaust and defecation,postoperative hospitalization days,total hospitalization expenses,recovery of hepatic function on postoperative day 1,3,5,total transfusion volume on postoperative day 1,2,3 and incidence of postoperative complications were compared between two groups.Results: All of patients were cured and discharged and there was no any perioperative death.There was no significant difference in the comparison of the preoperative general information and liver function between the ERAS group and the control group(P>0.05).There were 20 patients with abdominal distension after surgery,1 patient with hemorrhage of abdominal cavity,10 patients with pleural effusion,6 patients with bile leakage,7 patients with incision fat liquefaction and no patients with pulmonary infection in ERAS group,while 10 patients with abdominal distension after operation,13 patients with pleural effusion,9 patients with bile leakage,2 patients with pulmonary infection,9 patients with incision fat liquefaction and no patients with hemorrhage of abdominal cavity in the control group.There was no significant difference in the comparison of the total postoperative complications between the ERAS group and the control group(P>0.05).The time for postoperative anal exhaust and defecation,time of leaving bed,duration of postoperative hospital stay and expenses were(40.5±9.4)hours,(77.5±13.2)hours,(4.0±1.1)days,(12.3±3.6)days and(6.0±1.7)×104 RMB in the ERAS group,while(50.8±8.4)hours,(96.2±8.6)hours,(4.9±1.0)days,(15.4±5.9)days and(6.0±1.7)×104 RMB in control group,which was with significant differenees between the two groups(t=-8.980,-13.095,-6.812,-4.882,-2.794,all P<0.05).The total transfusion volume at postoperative day l,2,3 were(2382±421)mL / d 、(2106±523)mL/d、(1556±470)mL/d in the ERAS group,while(2965±625)mL/d,(2494±493)mL/d,(2119±504)mL/d in the control group,with significant differences between the two groups(t=-8.526,-5.943,-9.002,P<0.05).The levels of alanine transaminase at postoperative day 1,3,5 were 108.5 U/L、171.5 U/L、87.0 U/L in the ERAS group,while 172.0 U/L、212.5 U/L、102.5 U/L in the control group,with significant differences between the two groups(z=-2.152,-2.433,-2.202,P=0.031,0.015,0.028).The levels of Prealbumin at postoperative day 1,3,5 were 108.5 U/L、171.5 U/L、87.0U/L129.0 U/L、77.5 U/L、72.0 U/L in the ERAS group,while 118.0 U/L、68.0 U/L、64.5 U/L in the control group,with significant differences between the two groups(z=-2.152,-2.433,-2.202,P=0.031,0.015,0.028).The levels of Total bilirubin at postoperative day 1,3 were 15.9 ?mol/L、21.2 ?mol/L in the ERAS group,while 12.7 ?mol/L、16.7 ?mol/L in the control group,with significant differences between the two groups(z=-3.967,-2.994,P=0.000,0.003).Conclusions: principles of enhanced recovery after surgery to primary hepatocellular resection during perioperative surgery is feasible,effective and safe.It could not only accelerate the rehabilitation of patients,but also reduce the total length of hospital stay and hospital costs.