ERLS Improves Functional Status Post Oncologic Liver Surgery

Liver cancer patients undergoing hepatectomy, either open or laparoscopic, performed much better with respect to functional outcomes if they were placed on an Enhanced Recovery in Liver Surgery (ERLS) pathway versus if they were on a traditional pathway.

Enhanced recovery after surgery programs, introduced in colorectal surgery, have been proven to reduce postoperative morbidity and hospital length of stay. A perioperative protocol that includes optimization of gut function, analgesia, and mobility to attenuate the inflammatory response, hastens patient rehabilitation subsequent to surgery.

The current study, published in the Journal of the American College of Surgeons, included 118 hepatectomy patients—75 were on the ERLS care pathway while 43 received traditional care. The entire cohort rated symptom severity and life interference preoperatively and postoperatively at every outpatient visit for 31 days post surgery.

The ERLS patients were on a protocol that emphasized patient education, narcotic-sparing anesthesia and analgesia, rapid diet advancement, restrictive fluid administration, early ambulation, and avoidance of drains and tube. These patients, the authors write, reported a lower immediate postoperative score, were faced with fewer complications, and a shorter length of stay. Further, these patients who were on the modified protocol returned to their baseline function much faster (2.6 times faster) and also returned to their required oncology treatment much faster as measured by RIOT or Return to Intended Oncologic Therapy (44.7 days vs 60.2 days for those on the traditional protocol).

According to study author Thomas A. Aloia, MD, FACS, associate professor, department of surgical oncology, The University of Texas MD Anderson Cancer Center, Houston, “The only independent factor that correlated to faster return to baseline functional status, both in terms of absolute value and short time to recovery, was being on an enhanced recovery protocol. It wasn't the size of the liver resection, the approach [laparoscopic versus open operation], or whether we used an epidural catheter for pain control or not.”