Langenbeck's archives of surgery · 2026
Impact of enhanced recovery after surgery (ERAS) on postoperative morbidity and long-term survival in patients with perihilar cholangiocarcinoma.
СтатьяНазвание и аннотация: Перевод в очереди
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Oehring Robert, Keshi Eriselda, Breitkreuz Marlen, Zuehlke Alexandra, Knitter Sebastian, Moosburner Simon, Koch Pia F, Schöning Wenzel, Pratschke Johann, Neudecker Jens, Krenzien Felix
Аннотация
PURPOSE: Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care pathway designed to improve surgical outcomes and has been widely adopted across surgical disciplines. This study evaluated the impact of adherence to ERAS Society recommendations on postoperative complications and survival in patients undergoing surgery for perihilar cholangiocarcinoma (PCH).
METHODS: A total of 168 patients with PCH who underwent extended liver surgery with hepatobiliary reconstruction between 2014 and 2024 were included. Of these, 94 patients were treated according to the official ERAS protocol, while 74 patients treated prior to ERAS program implementation served as the control group (Non-ERAS). The ERAS program followed strictly the official ERAS Society guidelines. Patients were analyzed with regard to postoperative complications, adherence to ERAS measures, and long-term survival.
RESULTS: ERAS was associated with a significant reduction in overall complications (Clavien-Dindo grades 1-5), Non ERAS 97.3% vs. ERAS 83.0% (p = 0.003). Within the ERAS group, lower complication rates were observed in patients with higher adherence (≥ 50%) compared to those with lower adherence (< 50%), 78.2% vs. 100% (p = 0.031). Overall adherence in the ERAS group was 64.3%, with the highest adherence seen for preoperative items (80.7%). When ERAS was coordinated by dedicated ERAS staff, overall survival was significantly improved compared to the non-ERAS group (p = 0.037). However, this association was no longer observed after multivariable adjustment. Instead, the administration of adjuvant chemotherapy and younger age emerged as independent predictors of prolonged survival.
CONCLUSIONS: Implementation of the ERAS program in patients undergoing extended liver resection for PCH is feasible and safe. It was associated with a reduction in postoperative complications and a trend towards improved overall survival. These effects were most pronounced when the ERAS protocol was guided and supervised by dedicated ERAS staff.
METHODS: A total of 168 patients with PCH who underwent extended liver surgery with hepatobiliary reconstruction between 2014 and 2024 were included. Of these, 94 patients were treated according to the official ERAS protocol, while 74 patients treated prior to ERAS program implementation served as the control group (Non-ERAS). The ERAS program followed strictly the official ERAS Society guidelines. Patients were analyzed with regard to postoperative complications, adherence to ERAS measures, and long-term survival.
RESULTS: ERAS was associated with a significant reduction in overall complications (Clavien-Dindo grades 1-5), Non ERAS 97.3% vs. ERAS 83.0% (p = 0.003). Within the ERAS group, lower complication rates were observed in patients with higher adherence (≥ 50%) compared to those with lower adherence (< 50%), 78.2% vs. 100% (p = 0.031). Overall adherence in the ERAS group was 64.3%, with the highest adherence seen for preoperative items (80.7%). When ERAS was coordinated by dedicated ERAS staff, overall survival was significantly improved compared to the non-ERAS group (p = 0.037). However, this association was no longer observed after multivariable adjustment. Instead, the administration of adjuvant chemotherapy and younger age emerged as independent predictors of prolonged survival.
CONCLUSIONS: Implementation of the ERAS program in patients undergoing extended liver resection for PCH is feasible and safe. It was associated with a reduction in postoperative complications and a trend towards improved overall survival. These effects were most pronounced when the ERAS protocol was guided and supervised by dedicated ERAS staff.