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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2023; 15(3): 362-373
Published online Mar 27, 2023. doi: 10.4240/wjgs.v15.i3.362
Compliance with enhanced recovery after surgery predicts long-term outcome after hepatectomy for cholangiocarcinoma
Chaowasaporn Jongkatkorn, Vor Luvira, Chalisa Suwanprinya, Kantaruthai Piampatipan, Natwutpong Leeratanakachorn, Theerawee Tipwaratorn, Attapol Titapun, Tharatip Srisuk, Suapa Theeragul, Apiwat Jarearnrat, Vasin Thanasukarn, Ake Pugkhem, Narong Khuntikeo, Chawalit Pairojkul, Supot Kamsa-Ard, Vajarabhongsa Bhudhisawasdi
Chaowasaporn Jongkatkorn, Vor Luvira, Chalisa Suwanprinya, Kantaruthai Piampatipan, Theerawee Tipwaratorn, Attapol Titapun, Tharatip Srisuk, Suapa Theeragul, Apiwat Jarearnrat, Vasin Thanasukarn, Ake Pugkhem, Narong Khuntikeo, Vajarabhongsa Bhudhisawasdi, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
Natwutpong Leeratanakachorn, Department of Surgery, Saraburi Hospital, Saraburi 18000, Thailand
Chawalit Pairojkul, Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
Supot Kamsa-Ard, Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen 40002, Thailand
Author contributions: All the authors contributed to this paper.
Supported by the grant of Faculty of Medicine, Khon Kaen University, Thailand, No. IN62330.
Institutional review board statement: The Institutional Review Board, Office of Human Research Ethics, Khon Kaen University reviewed and approved this study (No. HE611590).
Informed consent statement: Since this study was a retrospective study, informed consent form is not needed.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at vor_110@yahoo.com.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Vor Luvira, FRCS (Gen Surg), MD, Associate Professor, Doctor, Surgical Oncologist, Department of Surgery, Faculty of Medicine, Khon Kaen University, Mittraphap Road, Muang Khon Kaen, Khon Kaen 40002, Thailand. vor_110@yahoo.com
Received: November 18, 2022
Peer-review started: November 18, 2022
First decision: November 30, 2022
Revised: December 9, 2022
Accepted: February 27, 2023
Article in press: February 27, 2023
Published online: March 27, 2023
BACKGROUND
Enhanced recovery after surgery (ERAS) program has been proved to improve postoperative outcome for many surgical procedures, including liver resection. There was limited evidence regarding the feasibility and benefit of ERAS in patients who underwent liver resection for cholangiocarcinoma.
AIM
To evaluate the feasibility of ERAS in patients who underwent liver resection for cholangiocarcinoma and its association with patient outcomes.
METHODS
We retrospectively analyzed 116 cholangiocarcinoma patients who underwent hepatectomy at Srinagarind Hospital, Khon Kaen University between January 2015 and December 2016. The primary outcome was the compliance with ERAS. To determine the association between ERAS compliance and patient outcomes. the patients were categorized into those adhering more than and equal to 50% (ERAS ≥ 50), and below 50% (ERAS < 50) of all components. Details on type of surgical procedure, preoperative and postoperative care, tumor location, postoperative laboratory results, and survival time were evaluated. The compliance with ERAS was measured by the percentage of ERAS items achieved. The Kaplan-Meier curve was used for survival analysis.
RESULTS
The median percentage of ERAS goals achieved was 40% (± 12%). Fourteen patients (12.1%) were categorized into the ERAS ≥ 50 group, and 102 patients were in the ERAS < 50 group. Postoperative hospital stay was significantly shorter in the ERAS ≥ 50 group [8.9 d, 95% confidence interval (CI): 7.3-10.4 d] than in the ERAS < 50 group (13.7 d, 95%CI: 12.2-15.2 d) (P = 0.0217). No hepatobiliary-related complications or in-hospital mortality occurred in the ERAS ≥ 50 group. Overall survival was significantly higher in the ERAS ≥ 50 group. The median survival of the patients in the ERAS < 50 group was 1257 d (95%CI: 853.2-1660.8 d), whereas that of the patients in the ERAS ≥ 50 group was not reached.
CONCLUSION
Overall ERAS compliance for patients who underwent liver resection for cholangiocarcinoma is poor. Greater ERAS compliance could predict in-hospital, short-term, and long-term outcomes of the patients.
Core Tip: The present study is the first and the largest study demonstrating the enhanced recovery program after surgery (ERAS) compliance and its association with short-term and long-term outcomes of cholangiocarcinoma patients. This study demonstrated that overall ERAS compliance in patients who underwent liver resection for cholangiocarcinoma was poor. The patients with high ERAS compliance were significantly associated with shorter postoperative hospital stay, and, interestingly, longer overall survival.
