Enhanced Recovery After Surgery in Patients With Hepatocellular Carcinoma Undergoing Laparoscopic Hepatectomy

Objective: To compare the effectiveness and safety of enhanced recovery after surgery (ERAS) in patients with hepatocellular carcinoma (HCC) undergoing laparoscopic hepatectomy.Methods: From September 2016 to June 2019, 282 patients were enrolled, and ERAS was implemented since March 2018. All indicators related to surgery, liver function, and postoperative outcomes were included in the analysis. Propensity score matching (PSM) identified 174 patients for further comparison.Results: After PSM, the clinicopathological baselines were well-matched. The group showed significantly less intraoperative blood loss (100.00 [100.00–200.00] vs. 200.00 [100.00–300.00] ml, P = 0.001), fewer days before abdominal drainage tube removal (4.00 [3.00–4.00] days vs. 4.00 [3.00–5.00] days, P = 0.023), shorter hospital stay after surgery (6.00 [5.00–6.00] days vs. 6.00 [6.00–7.00] days, P < 0.001), and reduced postoperative morbidity (18.39 vs. 34.48%, P = 0.026). The proportion of patients with a pain score ≥ 4 was significantly lower in the ERAS group within the first 2 days after surgery (1.15 vs. 13.79% and 8.05 vs. 26.44%, P = 0.002 and P = 0.001, respectively). Pringle maneuver was performed more frequently in the ERAS group (70.11 vs. 18.39%, P < 0.001), and a significantly higher postoperative alanine aminotransferase level was also observed (183.40 [122.85–253.70] vs. 136.20 [82.93–263.40] U/l, P = 0.026). The 2-year recurrence-free survival was similar between the two groups (72 vs. 71%, P = 0.946).Conclusions: ERAS programs are feasible and safe and do not influence mid-term recurrence in HCC patients undergoing laparoscopic hepatectomy.

Lymphatic leakage after pelvic lymphadenectomy for cervical cancer: a retrospective case-control study

Background The study aims to evaluate the clinical features and management of postoperative lymphatic leakage (PLL) in patients with cervical cancer who received pelvic lymphadenectomy. Methods This retrospective study screened consecutive patients with cervical cancer (stage Ia2-IIb). Results Among 3427 cases screened, 63 patients (1.8%) were diagnosed with PLL, which manifested as persistent abdominal drainage (42/63, 66.7%), chylous ascites (12/63, 19.0%) or vaginal drainage (9/63, 14.3%). Median time from surgery to onset of PLL was 6 days (range, 4–21 days). All cases resolved in a median 10 days (range, 3–56 days) after conservative treatment; although one case experienced recurrence of vaginal drainage after 26 days, this also resolved after conservative therapy. Multivariate analysis showed that two cycles of neoadjuvant chemotherapy (odds ratio [OR], 3.283; 95% confidence interval [95%CI], 1.289–8.360; P = 0.013), a decrease in hemoglobin level of ≥20 and < 30 g/L (OR, 6.175; 95%CI, 1.033–10.919; P = 0.046) or ≥ 30 g/L (OR, 8.467; 95%CI, 1.248–17.426; P = 0.029), and postoperative albumin level ≥ 30 and < 35 g/L (OR, 2.552; 95%CI, 1.112–5.857; P = 0.027) or < 30 g/L (OR, 5.517; 95%CI, 2.047–18.148; P = 0.012) were associated with PLL. Conclusion Neoadjuvant chemotherapy, postoperative anemia and postoperative hypoproteinemia are risk factors for PLL.

EP.TH.282Adherence to ERAS® Society recommendations following elective colonic surgery (2012) in regard to urinary drainage, postoperative nutritional care and intra-abdominal drainage

Aims Evaluating adherence to ERAS® recommendations for post-operative urinary drainage, nutritional care and intra-abdominal drain placement in elective colorectal surgery. Methods Approval was obtained by the audit department of a university teaching hospital. Data was collected prospectively over a seven-week period for nineteen (n = 19) patients. Results were compared against the standard set by the ERAS® Society (2012). Results Right colonic surgery (n = 5): catheter removed on post-operative day (POD) 1 n = 1 (20%), normal diet started on POD 0 or 1 n = 3 (60%), IV fluids discontinued on POD 1 n = 3 (60%) and n = 4 (80%) did not have a drain placed. High anterior resection or left/subtotal colectomy (n = 9): catheter removed on POD 1 n = 3 (33%), normal diet started on POD 0 or 1 n = 4 (44%), IV fluids discontinued on POD 1 n = 3 (33%) and n = 2 (22%) did not have a drain placed. Low rectal surgery (n = 4*, *one patient, n = 1, excluded from all domains except intra-abdominal drainage due to immediate post-op complication): catheter removed on POD 3 n = 4 (100%), normal diet started on POD 0 or 1 n = 2 (50%), IV fluids discontinued on POD 1 n = 1 (25%) and all patients had a drain placed n = 5 (100%). Conclusions Adherence for urinary drainage in low rectal surgery and intra-abdominal drainage for right colonic surgery was satisfactory. Multiple areas of improvement were identified, in order to optimise compliance, and recommendations were generated. The exception may be drains for lower rectal surgery where recent data has recommended selective drain placement.