Abstract: Objective:To investigate the clinical value of enhanced recovery after surgery (ERAS) in radical resection of hepatocellular carcinoma (HCC).
Methods:The propensity score matching (PSM) and retrospective cohort study were conducted. The clinicopathological data of 116 patients with HCC who were admitted to the Fuzhou General Hospital of Nanjing Command of PLA from June 2014 to January 2016 were collected. Fiftyeight patients using pre, intra and postoperative ERAS managements were allocated into the ERAS group and 58 using traditional perioperative managements were allocated into the control group. Observation indicators: (1) operation situations; (2) postoperative recovery: postoperative recovery time of bowel sound, time to initial anal exsufflation, time of drainagetube removal, levels of alanine transaminase (ALT), total bilirubin (TBil), Creactive protein (CRP) at 1, 3 and 7 days postoperatively, postoperative complications (vomiting, abdominal distension, wound infection, intraabdominal infection and pulmonary infection), duration of postoperative hospital stay, hospital expenses and satisfaction degree of patients; (3) followup situation. Followup using outpatient examination and telephone interview was performed to detect survival of patients up to March 2016. Measurement data with normal distribution were described as ±s. The comparison between groups was analyzed using the t test. Measurement data with skewed distribution were described as M (range). The comparison between groups was analyzed using the paried rank sum test. Repeated measurement data were evaluated by the repeated measures ANOVA.
Results:(1) Operation situations: all the patients underwent successful operations, without perioperative death. (2) Postoperative recovery: postoperative recovery time of bowel sound, time to initial anal exsufflation, time of drainagetube removal, levels of ALT, TBil and CRP at 1, 3 and 7 days postoperatively, duration of postoperative hospital stay, hospital expenses and satisfaction degree of patients were (49±10)hours, (60±10)hours, (3.3±0.7)days, (379±99)U/L, (222±65)U/L, (98±16)U/L, (20.4±4.7)μmol/L, (15.5±2.1)μmol/L, (13.4±1.8)μmol/L, (49±10)mg/L, (124±21)mg/L, (30± 5)mg/L, (9.7±0.9)days, (4.1±0.6)×104 yuan, 8.6±0.9 in the ERAS group and (53±5)hours, (64±7)hours, (6.2±1.6)days, (445±114)U/L, (278±79)U/L, (116±25)U/L, (18.6±3.5)μmol/L,(17.0±2.7)μmol/L, (14.2±1.9)μmol/L, (53±11)mg/L, (135±35)mg/L, (34±6)mg/L, (10.0±1.0)days, (4.3±0.5)×104 yuan, 8.2±1.0 in the control group, respectively, with statistically significant differences between the 2 groups (t=2.537, 2.479,2.065, F=20.075, 14.357, 13.460, t=2.060, 2.197, 2.370, P<0.05). Number of patients with postoperative vomiting, abdominal distension, wound infection, intraabdominal infection and pulmonary infection were 5, 3, 2, 1, 1 in the ERAS group and 6, 6, 7, 5, 3 in the control group, respectively, with no statistically significant difference between the 2 groups x²= 0.100, 1.084, 3.011, 0.206, 0.618, P>0.05). (3) Followup situation: all the 116 patients were followed up for 1-20 months, with a median time of 11 months. During the followup, 2 patients in the ERAS group died (1 dying of tumor recurrence and 1 dying of respiratory failure) and 3 in the control group died (1 dying of multiple organs metastasis, 1 dying of lung metastasis of HCC and 1 dying of myocardial infarction).
Conclusion:ERAS in the perioperative management after radical resection of HCC is safe and effective, and it can quickly improve postoperative recovery of patients.