Enhanced recovery program in liver surgery

Nari, Gustavo A.; López, Alesio E.; Mariot, Ana D.; Layún, José L.; Nari, Gustavo A.; López, Alesio E.; Mariot, Ana D.; Layún, José L.

doi:10.25132/raac.v113.n3.1640

Services on Demand

Journal

Article

Indicators

Cited by SciELO

Revista argentina de cirugía

Print version ISSN 2250-639XOn-line version ISSN 2250-639X

Rev. argent. cir. vol.113 no.3 Cap. Fed. Sept. 2021

http://dx.doi.org/10.25132/raac.v113.n3.1640

Articles

Enhanced recovery program in liver surgery

Gustavo A. Nari¹²^*

Alesio E. López¹

Ana D. Mariot²

José L. Layún²

^¹ Servicio de Cirugía. Hospital Tránsito Cáce res de Allende. Córdoba, Argentina.

^² Sector de Cirugía Oncológica Sanatorio La Cañada. Córdoba, Argentina.

Introduction

Since Kehlet and Wilmore introduced a successful fast track recovery program in colorectal surgery¹, the implementation of this type of program in other organs such as the stomach and pancreas, among others, had a multiplying effect^2-13. The primary aim of enhanced recovery programs (ERP) is to reduce the typical physiological neuroendocrine stress response to surgery to return a patient rapidly and effectively to his or her normal or nearly normal homeostasis¹⁴. These results reduce length of hospital stay which, in turn, decreases hospital costs. These programs have also reduced morbidity and mortality and have an economic impact⁷.

Liver surgery is in permanent progress and allows patients to gain access to surgical procedures that 10 years ago would have been denied. Thus, the development of more reliable anesthesia strategies that provide better management of surgical strategies, as simultaneous resections, redo liver resections, classic two-stage procedures, portal vein embolization or ALPPs has increased the volume of patients undergoing liver resection^15-17.

Liver resections have not been excluded from an ERP: there are several studies analyzing the results of the implementation of these multimodal programs^18-32. Although there are protocols that differ in the variables used and evaluated, most authors agree in reporting a significant reduction in length of hospital stay. This reduction represented a considerable reduction in costs when compared with the usual perioperative management³³.

Despite some contradictions, a decrease in the number of complications is repeatedly mentioned in the literature¹⁴^,³⁴. Another important aspect to consider is that most patients undergoing liver resections have cancer, and the usefulness of these programs to continue with the necessary cancer therapy after the oncological resection has recently come into focus³⁵.

The aim of this paper is to review most of the elements constituting an ERP throughout the entire process of patient care and other considerations such as adherence to programs, full recovery, length of hospital stay, complications, and costs. We will conclude with comments on our own experience with an ERP pathway in liver surgery.

Enhanced recovery pathway

Surgical trauma generates a wide range of endocrine, metabolic, immunological and hematological changes which induce a complex process of body stress. Among them, insulin resistance is a major event and an independent predictor of length of hospital stay. Among the hematological changes, hypercoagulability and fibrinolysis occur as a result of the release of cytokines and other acute-phase reactants induced by surgical stress.

Surgery-induced immunosuppression is the result of increased release of cortisol³⁶. Other effects of surgical trauma are increased myocardial oxygen demand, hypoxemia, splanchnic vasoconstriction, impaired healing of anastomoses and scars with increased risk of infections, and fluid and sodium retention, among others³⁶.

The multimodal pathway developed to overcome the deleterious effect of perioperative stress improves postoperative recovery. These enhanced recovery programs implement specific preoperative, intraoperative and postoperative measures to achieve the goals previously mentioned (Fig. 1).

Figure 1 Components of the ERAS (Enhanced Recovery After Surgery) program. Modified from L. Sánchez-Urdazpal González et al.³⁶ NSAIDs, non-steroidal anti-inflammatory drugs

The implementation of these programs involves a multidisciplinary management with the participation of surgeons, anesthesiologists, nurses, physical therapists, nutritionists and the family environment. The education and training of this multidisciplinary team and the development of protocols with periodic review, will result in the success of the ERP selected. This team should systematically work to facilitate the processes to promote greater adherence, and each of the data assessed and collected should be uploaded and evaluated periodically to make the necessary interventions to improve the results.

Preoperative care

Patient evaluation, information and adherence

The medical visit should include detailed anamnesis. Understanding patient’s comorbidities is extremely important when deciding whether to incorporate these patients into an ERP pathway, since postoperative morbidity is directly related with these comorbidities¹⁴^,³⁶. Improving and correcting these conditions will promote better recovery. The use of medications that could affect the results of an ERP, as anticoagulants, corticosteroids or narcotics should also be recorded³⁷^,³⁸.

A history of radiation therapy and chemotherapy should be inquired in patients with cancer.

Assessment of the psychological status is particularly valuable; patients who deny reality or those extremely anxious should be given special attention³⁹^,⁴⁰.

In addition, better results can be achieved by providing detailed information about the surgical procedure, possible complications and their treatment, ERP items and the need for the patient and his or her family environment to collaborate; these results can be evidenced by the adherence to each of the items of the program. Special emphasis should be placed on reporting early postoperative mobilization, initiation of oral intake and management of analgesia, as this is where the least adherence has been achieved⁴¹.

The use of written material with plain and simple language, ideally indicating the most relevant aspects of the program, is helpful when trying to obtain the greatest cooperation from the patient and family members.

Preoperative nutritional status and fasting

The ERAS society recommends considering the nutritional status of the patient to be included in an ERP, particularly if he/she is an oncologic patient. The ERAS guidelines recommend nutritional optimization for patients with weight loss of 15% in the last 6 months, serum albumin< 3 g/dL or body mass index (BMI) < 18 kg/m²³². Screening tools used to evaluate malnutrition, as MUST (Malnutrition Universal Screening tool) and MNA-sf (Mini-Nutritional Assessment-Short Form), have a diagnostic accuracy of about 80%.

Some authors have reported that about 50% of patients with colorectal cancer and 80% of those with pancreatic cancer present cachexia⁴². Nutritional optimization should be considered and will impact on the final results of an ERP.

Traditionally, patients undergoing surgery were required to fast for 6 hours due the risk of reflux and lung aspiration. Later, several studies showed that prolonged fasting favored a reduction in liver glucagon stores and increased insulin resistance,⁴³^,⁴⁴, which proved to be an independent factor for increasing length of hospital stay⁴⁵. The current protocols recommend carbohydrate-rich drinks 2 h before surgery to reduce insulin resistance and symptoms related like weakness, nausea, anxiety thirst or hunger, and 6-hour fasting for solids³².

This 2-hour period before surgery is based on a study that demonstrated that carbohydrate-rich drinks remain in the stomach not more than 90 minutes without increasing gastric acidity⁴⁶^,⁴⁷.

Immunonutrition is also mentioned as a factor that could reduce length of hospital stay and infections³²^,⁴⁸. So far, the use of omega-3 fatty acids and arginine has not demonstrated to achieve the expected effects⁴⁹^,⁵⁰.

Anti-thrombotic and antibiotic prophylaxis

Most cancer patients who will undergo liver resection are at increased risk of thromboembolism, and therefore systematic anti-thrombotic prophylaxis is recommended⁵¹. The use of risk scores is recommended to identify high-risk patients. Low-molecular-weight heparin (LMWH) treatment should be initiated 2-12 h before surgery and continued until patients are fully mobile⁵²^,⁵³.

As the risk of complications with the use of epidural analgesia still needs to be assessed, heparin should be administered 12 h prior to insertion of epidural catheter³⁵. There is no evidence about the effectiveness of antibiotic therapy⁵⁴^,⁵⁶, but much depends on the reason for liver resection. In any case and considering that patients undergoing liver resection require other invasive procedures (urinary catheter and central line, among others), the recommendation is to use a broad-spectrum antibiotic before surgery.

Bowel preparation

Bowel preparation could be indicated in patients undergoing simultaneous resection of the colon and liver lesions. There are two reasons for not indicating bowel preparation: the possibility of generating fluid and electrolyte imbalances³²^,⁵⁶ that will delay recovery mainly in elderly patients and, in case of simultaneous resections¹⁵, there are no differences in the development of anastomotic leaks with and without bowel preparation.

Pre-anesthetic medication

The preoperative use of anxiolytics is still under discussion; patients’ ability to move around, drink and eat would be reduced in the postoperative period⁵⁷. In our opinion, in patients undergoing major liver resections this would be exacerbated by a delay in the metabolism of these drugs.

Intraoperative care

Multimodal analgesia

An adequate multimodal analgesia regime that is usually initiated in the operating room should be implemented in association with general anesthesia. The aim of an adequate analgesia is to reduce the metabolic and endocrine response to surgical stress and postoperative pain. The reduction in the use of opioids for pain relief is one of the issues to consider since their adverse effects often delay the postoperative recovery of patients¹⁴.

Gastrointestinal dysmotility associated with the use of opioids leads to abdominal bloating, nausea and vomiting, and prolongs length of hospital stay. The use of opioids in clinically relevant doses could stimulate angiogenesis by activating proangiogenic factors and promote tumor progression⁵⁸.

The activation of Mu opioid receptor could promote cellular proliferation in lung cancer⁵⁹. Different analgesia regimes have been suggested to reduce surgical stress, which can start in the preoperative period with the association of pregabalin and anti-inflammatory agents, the use of intrathecal morphine, placement of epidural catheters, or regional blocks¹⁴^,^60-64. All these regimes reduce the postoperative use of opioids and allow earlier mobilization. Transversus abdominis plane (TAP) block involves the injection of approximately 30 mL of bupivacaine 0.25% into a plane between the internal oblique muscle and transversus abdominis muscle followed by a continuous infusion of 5 mL/h of ropivacaine 0.2%. Another possibility is a single dose of lyposomal bupivacaine 1.3%in 30 mL saline infiltrated in the plane of the transversus abdominis muscle⁶⁰.

The use of epidural catheter has shown favorable results in reducing length of hospital stay and providing adequate pain control in the immediate postoperative period. Yet, the risk of hypotension and bleeding in patients receiving anti-thrombotic prophylaxis for major liver surgery may exist, due to decreased prothrombin levels secondary to major liver resection¹⁴^,³².

Some authors did not find superiority in the use of epidural catheter vs. TAP block¹⁴. On the other hand, Agarwal et al. reported that epidural analgesia provides better analgesia and reduces the need for rescue dose of intravenous opioids⁶⁵.

The use of intrathecal morphine, even when compared to epidural analgesia, has proved to be a good alternative and does not present the possible complications associated with catheter placement; yet there are limitations for administering new doses and achieving greater analgesia⁶⁶^,⁶⁷.

Fluid therapy

The aim of goal-directed fluid therapy is to maintain euvolemia and avoid salt and water excess, while preserving renal function³²^,⁵²^,⁶⁸. Figure 2 shows some consequences of excess and insufficient fluid supply.

Figure 2 Potential consequences of inadequate fluid intake. Modified from L. Sánchez-Urdazpal González et al.³⁶

Major liver resections require low central venous pressure and restrictive fluid therapy approach to reduce bleeding during the stage of parenchymal transection⁶⁹. These measures would reduce bleeding by 500% and the need for transfusion from 48% to 5%³⁶.

To achieve adequate fluid intake, easily available measures like diuresis (near zero), blood pressure, central venous pressure (CVP) or BUN are used to ensure that patients do not gain more than 5% of their preoperative body weight¹⁴^,⁶⁸; hemodynamic parameters like variation of stroke volume variation or pulse pressure are reliable predictors of fluid responsiveness¹⁴^,⁶². Serum brain natriuretic peptide (BNP), a 32-amino acid protein released by the dilated atria and ventricles due to increased volume and pressure, reliably translates changes in fluid balance and resuscitation, and is another measure to be used¹⁴^,⁷⁰.

Hypoglycemia, hypophosphatemia and hyponatremia should be avoided, and some authors recommend fluid replacement with sodium chloride 0.9% with dextrose 5% and 16 mmol of phosphorus during the first 24 postoperative hours⁵².

Finally, although the ERAS society strongly recommends goal-directed fluid therapy³², some authors have not been able to demonstrate a reduction in the number of complications or in length of hospital stay⁷¹.

Prevention of hypothermia

The use of warming blankets during and after surgery decreases the endocrine and metabolic response to surgical stress³⁶. Maintaining normothermia during surgery reduces the number of cardiac complications and infections⁷²^,⁷³.

Nasogastric tube

The use of nasogastric tubes during surgery was justified to prevent pulmonary aspiration before orotracheal intubation when reflexes are completely suppressed. However, a meta-analysis showed that the insertion of nasogastric tubes did not reduce postoperative ileus or the percentage of aspirations⁷⁴. Later, some reports suggested that nasogastric intubation is usually unnecessary and delays the recovery of bowel motility in the postoperative period⁷⁵. Currently, many studies have demonstrated that its use in liver surgery is associated with more pulmonary complications and thus, nasogastric intubation would not be necessary⁷⁶.

Urinary catheter

Urinary catheter is useful to monitor diuresis during surgery and can be kept in place within the first hours after surgery, especially in patients with epidural catheters inserted as part of multimodal analgesia⁷⁷. The catheter should be removed within 24 hours after surgery to prevent urinary tract infections. In patients undergoing liver surgery who develop urinary retention, intermittent catheterization can be performed following strict antisepsis measures.

Abdominal drainage

Abdominal drainage has been a common practice in gastrointestinal surgery to avoid collections, serve as a warning sign of anastomotic leak and treat a fistula. In 1933, Mirizzi⁷⁸ described cholecystectomy without drainage and detailed the requirements for its implementations, which were later confirmed by other authors⁷⁹ and applied in colorectal surgery⁸⁰.

The development of minimally invasive procedures associated with technological development and better access to diagnostic imaging tests has improved the early diagnosis and rapid intervention in the treatment of complications.

In the early 1990s, different authors reported that the use of drains was not necessary after liver resections⁸¹^,⁸², and these findings were recently confirmed by other authors⁸³. However, in a series of 1269 liver resections, other authors found that placement of drains after liver resections decreased the number of subphrenic collections and bilomas or biliary fistulas.

Probably, differentiating between major and minor liver resections would provide more accurate knowledge when deciding on inserting an abdominal drain. While some authors recommend abdominal drainage in liver resections for more than 350 minutes when blood loss is greater than 650 mL or in case of bile leakage during surgery⁸⁵, others suggest placement of drains in patients with associated thoracotomy, when bile leakage control cannot be assured, associated biliary anastomosis or surgical site infection⁸⁶. We believe that abdominal drainage should be considered in patients undergoing simultaneous colorectal and liver resections.

Surgical approach

All the studies agree that liver resections within an ERP reduces length of hospital stay, other studies also indicate a reduction in the rate of complications, while others state that the number of complications is similar to that observed with liver resections managed with the standard approach³³^,⁴¹^,^87-94.

According to different authors, the minimally invasive approach has several advantages over open surgery, including shorter length of hospital stay, less bleeding, and better oncologic results, among others⁸⁷^,⁹⁵^,⁹⁶. There are few studies comparing the open approach versus laparoscopic approach within an ERP⁹².

Some authors compared laparoscopic liver resections with an ERP pathway versus the standard approach and reported that length of hospital stay was much shorter within an ERP pathway than with standard care; these authors reported an average length of hospital stay for the non-ERP group of 8 days, which is similar to that of standard care for open liver resections. On the other hand, length of hospital stay for laparoscopic hepatectomy within an ERP ranged between 2 and 5 days. Of note, length of hospital stay was shorter in only 9% of the patients who underwent major hepatectomy.

Other publications concluded that there are no remarkable differences between open versus laparoscopic hepatectomies within an ERP pathway⁸⁸^,⁸⁹. The ORANGE II study, which could not be completed, showed no differences in terms of length of hospital stay, morbidity, reoperation, readmission and mortality⁸⁸. One of those studies did not find differences in length of hospital stay between major and minor liver resections⁸⁹.

We have not observed any benefit between laparoscopic surgery and open surgery in terms of length of hospital stay or morbidity⁹².

There is not sufficient evidence demonstrating the superiority of laparoscopic surgery over open surgery; in addition, costs of minimally invasive surgery are much higher in terms of technology, disposable instruments and longer operative time¹⁴.

Postoperative care

Prevention of postoperative nausea and vomiting, early oral intake and stimulation of bowel motility

The use of anesthetic drugs and postoperative ileus contribute to nausea and vomiting; one of the main conditions for initiating early food intake is to prevent nausea and vomiting and promote early bowel motility⁵². Antiemetics such as metochlorpramide and ondansetron are usually administered before extubation and are continued on a regular basis in the postoperative period. Early oral intake should be encouraged in major liver resections except in those with simultaneous colectomy. Some authors have demonstrated that early oral intake does not increase the number of complications and reduces the duration of postoperative ileus⁹⁷. Previous studies have shown that early enteral nutrition after liver resection improves postoperative immune competence and decreases the rate of infections⁹⁸.

Bowel motility can also be stimulated with the use of laxatives that increase the passage of stool⁹⁹.

Early mobilization: prolonged bed rest is associated with complications as respiratory disorders, venous thromboembolism, postoperative ileus, muscle atrophy and insulin resistance¹⁰⁰. In a RCT involving 120 patients who underwent liver resections, early mobilization not only prevented the complications mentioned above but also reduced postoperative pain with less need for analgesics and lower costs, increased patient’s comfort and reduced nursing workload, thus improving patient satisfaction¹⁰¹. In another study involving 223 patients in which 66% underwent major hepatectomies, early mobilization was one of the keys for ERP success¹⁰².

In patients undergoing open surgery and who present obesity or conditions that may lead to the development of eviscerations in the immediate postoperative period, special considerations should be considered.

Other considerations and results

Adherence to the program is one of the fundamental items to achieve good results; in agreement with some authors¹⁴, adherence is attained in the first visit, where -as we have already stated- the patient receives all the information about the scope of the program and what is expected of him/her. The adherence to most preoperative and intraoperative items is 100%, but this situation changes in the postoperative period, when pain management, early mobilization and early intake may not meet the proposed goals³^,⁴¹. We believe that 75% of adherence to the programs provide clear benefit for the patient. Before hospital discharge, full recovery should be measured using the following criteria:1) pain management with oral analgesics, 2) no use of intravenous fluids, 3) recovery of mobilization to preoperative level or similar, 4) intake of solid food, and 5) normal or decreasing serum bilirubin levels. In this item mobilization and pain management are usually the most difficult.

All the publications agree that the most outstanding result is a clear reduction in length of hospital stay, about 3 days less than that of standard care for liver resections⁴¹^,⁹³^,⁹⁴^,¹⁰³. In this regard, a comparison between major and minor hepatectomies should be made since the latter are less complex.

As we have mentioned, there is no agreement about the number of complications. While some authors stated that complications decreased with the implementation of an ERP, other authors²⁰ reported that there were no differences in the rate of complications between an ERP pathway versus standard management; nevertheless, standard care was associated with more serious complications. In this sense, it is also important to determine the number of major liver resections in each group.

The association between shorter length of hospital stay and the rate of complications has a strong impact on the costs of this type of surgery, with lower costs in laboratory tests and in nursing care. This cost is about 40% compared with standard management, with saving of about 700 dollars in the both items³³. In a systematic review of colorectal and pancreatic surgery comparing ERP with standard management, the authors reported a cost reduction of $3010 and $7020, respectively, for an ERP pathway¹⁰⁴.

Finally, the delay to resume cancer treatment after surgery is particularly important in oncologic patients. In patients operated on within an ERP, the delay to adjuvant chemotherapy is shorter than that of patients managed with standard care³⁵. In hepatobiliary and pancreatic surgery within an ERP pathway, a 67% improvement was observed in the interval to chemotherapy¹⁰⁵.

Our experience

In 2016, we started an ERP in liver resections for colorectal liver metastases. When we compared these patients with a previous series of liver resections for the same cause managed with standard care, we confirmed one of the most important advantages of including hepatectomies in an ERP: a reduction of about 50% in length of hospital stay⁴¹.

These findings were later confirmed with a higher number of cases in 2019, but already in liver resections due to different conditions. In this new series, median length of hospital stay was 3.4 days and 3.6 days when readmissions were added. The rate of complications was not different from standard management, as in previous findings⁹¹.

In a subsequent paper we reported the results of a study performed in two institutions comparing open versus laparoscopic liver resections within an ERP pathway⁹².

In that study, we found that the reduction in length of hospital stay was similar and that the number of complications was not significantly different between both approaches.

In another study performed in the same two institutions, of 80 liver resections 47 were open procedures and the rest were laparoscopic surgeries¹⁰⁶. There were no significant differences in the number of major hepatectomies between the two groups, but simultaneous resections were more common in the open surgery group, while length of hospital stay and complications were similar.

The use of drains was lower and the urinary catheter was removed earlier with the laparoscopic approach, while operative time was shorter and mobilization was earlier with open surgery.

These findings make us think that the type of approach with an ERP pathway for liver resections does not have the relevance attributed by different authors.

Conclusions

We believe that the implementation of an ERP in liver resections is necessary and has good results in centers dedicated to this type of surgery. The creation of a multidisciplinary team with the necessary skills and knowledge to carry out an ERP should always be the starting point. While we believe that patient education and adherence, goal-directed fluid therapy, adequate analgesia, early mobilization and early oral intake are the strongest items of an ERP, we consider that favorable results will unfailingly depend on the synergistic use of all the items of the program. The implementation of an ERP has undoubtedly demonstrated a significant reduction in length of hospital stay and costs.

Referencias bibliográficas /References

1. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183(6):630-41. doi: 10.1016/s0002-9610(02)00866-8. PMID: 12095591. [ Links ]

2. Coolsen MM, van Dam RM, van der Wilt AA, Slim K, Lassen K, Dejong CH. Systematic review and meta-analysis of enhanced recovery after pancreatic surgery with particular emphasis on pancreaticoduodenectomies. World J Surg. 2013;37(8):1909-18. doi: 10.1007/s00268-013-2044-3. PMID: 23568250. [ Links ]

3. Gillissen F, Ament SM, Maessen JM, Dejong CH, Dirksen CD, van der Weijden T, von Meyenfeldt MF. Sustainability of an enhanced recovery after surgery program (ERAS) in colonic surgery. World J Surg. 2015;39(2):526-33. doi: 10.1007/s00268-014-2744-3. PMID: 25148885. [ Links ]

4. Patrón Uriburu JC, Tanoni B, Ruiz H, Cillo M, Bugallo F, Tyrrell C, Salomón M. Protocolo ERAS en cirugía colónica laparoscópica: evaluación de una serie inicial. Rev Argent Cirug. 2015;107(2):63-71. [ Links ]

5. Connor S, Cross A, Sakowska M, Linscott D, Woods J. Effects of introducing an enhanced recovery after surgery programme for patients undergoing open hepatic resection. HPB (Oxford). 2013;15(4):294-301. doi: 10.1111/j.1477-2574.2012.00578.x. Epub 2012 Oct 4. PMID: 23458488; PMCID: PMC3608984. [ Links ]

6. Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr. 2010;29(4):434-40. doi: 10.1016/j.clnu.2010.01.004. Epub 2010 Jan 29. PMID: 20116145. [ Links ]

7. Muller S, Zalunardo MP, Hubner M, Clavien PA, Demartines N; Zurich Fast Track Study Group. A fast-track program reduces complications and length of hospital stay after open colonic surgery. Gastroenterology. 2009;136(3):842-7. doi: 10.1053/j.gastro.2008.10.030. Epub 2008 Nov 1. PMID: 19135997. [ Links ]

8. Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev. 2011;(2):CD007635. doi: 10.1002/14651858.CD007635.pub2. PMID: 21328298. [ Links ]

9. Serclová Z, Dytrych P, Marvan J, Nová K, Hankeová Z, Ryska O, et al. Fast-track in open intestinal surgery: prospective randomized study (Clinical Trials Gov Identifier no. NCT00123456). Clin Nutr. 2009;28(6):618-24. doi: 10.1016/j.clnu.2009.05.009. Epub 2009 Jun 17. PMID: 19535182. [ Links ]

10. Lv L, Shao YF, Zhou YB. The enhanced recovery after surgery (ERAS) pathway for patients undergoing colorectal surgery: an update of meta-analysis of randomized controlled trials. Int J Colorectal Dis. 2012;27(12):1549-54. doi: 10.1007/s00384-012-1577-5. Epub 2012 Sep 22. PMID: 23001161. [ Links ]

11. Anderson AD, McNaught CE, MacFie J, Tring I, Barker P, Mitchell CJ. Randomized clinical trial of multimodal optimization and standard perioperative surgical care. Br J Surg. 2003;90(12):1497- 504. doi: 10.1002/bjs.4371. PMID: 14648727. [ Links ]

12. Gatt M, Anderson AD, Reddy BS, Hayward-Sampson P, Tring IC, MacFie J. Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection. Br J Surg. 2005;92(11):1354-62. doi: 10.1002/bjs.5187. PMID: 16237744. [ Links ]

13. Eskicioglu C, Forbes SS, Aarts MA, Okrainec A, McLeod RS. Enhanced recovery after surgery (ERAS) programs for patients having colorectal surgery: a meta-analysis of randomized trials. J Gastrointest Surg. 2009;13(12):2321-9. doi: 10.1007/s11605-009-0927-2. Epub 2009 May 21. PMID: 19459015. [ Links ]

14. Lillemoe HA, Aloia TA. Enhanced Recovery After Surgery: Hepatobiliary. Surg Clin North Am. 2018;98(6):1251-1264. doi: 10.1016/j.suc.2018.07.011. Epub 2018 Aug 24. PMID: 30390857; PMCID: PMC6345553. [ Links ]

15. Nari GA, López-Ben S, Mariot D, Albiol M, Góngora-Ortega J, Figueras J. Synchronous liver metastases from colorectal origin. Simultaneous or staged resection? Cir Cir. 2018;86(6):648-653. DOI: 10.24875/CIRUE.M18000081. [ Links ]

16. Nari G Layún J, Molina L, Barrionuevo L, Ortega E, López A. Hepatectomía en dos tiempos con resección colorrectal simultánea abierta en el tratamiento multimodal de las metástasis hepáticas de origen colorrectal. Rev Argent Cirug. 2017;109:188-92. 10.25132/raac.v109.n4.1296.es. [ Links ]

17. Nari G, Mariot D, Góngora-Ortega J, López-Ben S, Albiol M, Figueras J. Short and long-term outcomes of the re-hepatectomies as part of multi-modal treatment of hepatic metastases from colo-rectal origin. Bi-institutional study [Resultados a corto y largo plazo de las rehepatectomías como parte del tratamiento multimodal de las metástasis de origen colorrectal. Un estudio biinstitucional]. Cir Cir. 2018;86(4):347- 54. Spanish. doi: 10.24875/CIRU.M18000053. PMID: 30067717. [ Links ]

18. Li L, Chen J, Liu Z, Li Q, Shi Y. Enhanced recovery program versus traditional care after hepatectomy: A meta-analysis. Medicine (Baltimore). 2017;96(38):e8052. doi: 10.1097/MD.0000000000008052. PMID: 28930840; PMCID: PMC5617707. [ Links ]

19. Brustia R, Slim K, Scatton O. Enhanced recovery after liver surgery. J Visc Surg. 2019;156(2):127-37. doi: 10.1016/j.jviscsurg.2018.10.007. Epub 2018 Nov 14. PMID: 30447936. [ Links ]

20. Dasari BV, Rahman R, Khan S, Bennett D, Hodson J, Isaac J, et al. Safety and feasibility of an enhanced recovery pathway after a liver resection: prospective cohort study. HPB (Oxford). 2015;17(8):700-6. doi: 10.1111/hpb.12447. Epub 2015 Jun 23. PMID: 26099347; PMCID: PMC4527855. [ Links ]

21. Wang C, Zheng G, Zhang W, Zhang F, Lv S, Wang A, Fang Z. Enhanced Recovery after Surgery Programs for Liver Resection: a Meta-analysis. J Gastrointest Surg. 2017;21(3):472-86. doi: 10.1007/s11605-017-3360-y. Epub 2017 Jan 18. PMID: 28101720. [ Links ]

22. Teixeira UF, Goldoni MB, Waechter FL, Sampaio JA, Mendes FF, Fontes PRO. Enhanced recovery (ERAS) after liver surgery: comparative study in a brazilian terciary center. Arq Bras Cir Dig. 2019;32(1):e1424. doi: 10.1590/0102-672020180001e1424. PMID: 30758472; PMCID: PMC6368150. [ Links ]

23. Jones C, Kelliher L, Dickinson M, Riga A, Worthington T, Scott MJ, et al. Randomized clinical trial on enhanced recovery versus standard care following open liver resection. Br J Surg. 2013;100(8):1015-24. doi: 10.1002/bjs.9165. Epub 2013 May 21. PMID: 23696477. [ Links ]

24. Hughes MJ, McNally S, Wigmore SJ. Enhanced recovery following liver surgery: a systematic review and meta-analysis. HPB (Oxford). 2014;16(8):699-706. doi: 10.1111/hpb.12245. Epub 2014 Mar 24. PMID: 24661306; PMCID: PMC4113251. [ Links ]

25. Chong CCN, Chung WY, Cheung YS, Fung AKY, Fong AKW, Lok HT, et al. Enhanced recovery after surgery for liver resection. Hong Kong Med J. 2019;25(2):94-101. doi: 10.12809/hkmj187656. Epub 2019 Mar 27. PMID: 30919808. [ Links ]

26. Qi S, Chen G, Cao P, Hu J, He G, Luo J, He J, Peng X. Safety and efficacy of enhanced recovery after surgery (ERAS) programs in patients undergoing hepatectomy: A prospective randomized controlled trial. J Clin Lab Anal. 2018;32(6):e22434. doi: 10.1002/jcla.22434. Epub 2018 Mar 24. PMID: 29574998; PMCID: PMC6816868. [ Links ]

27. Nakanishi W, Miyagi S, Tokodai K, Fujio A, Sasaki K, Shono Y, et al. Effect of enhanced recovery after surgery protocol on recovery after open hepatectomy: a randomized clinical trial. Ann Surg Treat Res. 2020;99(6):320-8. doi: 10.4174/astr.2020.99.6.320. Epub 2020 Nov 26. PMID: 33304859; PMCID: PMC7704272. [ Links ]

28. Rouxel P, Beloeil H. Enhanced recovery after hepatectomy: A systematic review. Anaesth Crit Care Pain Med. 2019;38(1):29- 34. doi: 10.1016/j.accpm.2018.05.003. Epub 2018 May 26. PMID: 29807132. [ Links ]

29. Ni TG, Yang HT, Zhang H, Meng HP, Li B. Enhanced recovery after surgery programs in patients undergoing hepatectomy: A meta-analysis. World J Gastroenterol. 2015;21(30):9209- 16. doi: 10.3748/wjg.v21.i30.9209. PMID: 26290648; PMCID: PMC4533053. [ Links ]

30. Wong-Lun-Hing EM, van Dam RM, Heijnen LA, Busch OR, Terkivatan T, van Hillegersberg R, et al. Is current perioperative practice in hepatic surgery based on enhanced recovery after surgery (ERAS) principles? World J Surg. 2014;38(5):1127-40. doi: 10.1007/s00268-013-2398-6. PMID: 24322177. [ Links ]

31. Song W, Wang K, Zhang RJ, Dai QX, Zou SB. The enhanced recovery after surgery (ERAS) program in liver surgery: a meta-analysis of randomized controlled trials. Springerplus. 2016;5:207. doi: 10.1186/s40064-016-1793-5. PMID: 27026903; PMCID: PMC4770001. [ Links ]

32. Melloul E, Hübner M, Scott M, Snowden C, Prentis J, Dejong CH, et al. Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations. World J Surg. 2016;40(10):2425-40. doi: 10.1007/s00268-016-3700-1. PMID: 27549599. [ Links ]

33. Page AJ, Gani F, Crowley KT, Lee KH, Grant MC, Zavadsky TL, et al. Patient outcomes and provider perceptions following implementation of a standardized perioperative care pathway for open liver resection. Br J Surg. 2016;103(5):564-71. doi: 10.1002/bjs.10087. Epub 2016 Feb 9. PMID: 26859713. [ Links ]

34. Page AJ, Ejaz A, Spolverato G, Zavadsky T, Grant MC, Galante DJ, et al. Enhanced recovery after surgery protocols for open hepatectomy--physiology, immunomodulation, and implementation. J Gastrointest Surg. 2015;19(2):387-99. doi: 10.1007/s11605-014-2712-0. Epub 2014 Dec 4. PMID: 25472030. [ Links ]

35. Day RW, Cleeland CS, Wang XS, Fielder S, Calhoun J, Conrad C, et al. Patient-Reported Outcomes Accurately Measure the Value of an Enhanced Recovery Program in Liver Surgery. J Am Coll Surg. 2015;221(6):1023-30.e1-2. doi: 10.1016/j.jamcollsurg.2015.09.011. Epub 2015 Oct 21. PMID: 26611799. [ Links ]

36. Sánchez-Urdazpal González L, Salido Fernández S, Alday Muñoz E, Gómez Martín-Tesorero L, Molina Baena B. Implantación de un programa ERAS en cirugía hepática [Implementation of an ERAS program in liver surgery]. Nutr Hosp. 2015;31 (Suppl 5):16-29. Spanish. doi: 10.3305/nh.2015.31.sup5.9128. PMID: 25938602. [ Links ]

37. Kim Y, Cortez AR, Wima K, Dhar VK, Athota KP, Schrager JJ, et al. Impact of Preoperative Opioid Use after Emergency General Surgery. J Gastrointest Surg. 2018;22(6):1098-103. doi: 10.1007/s11605-017-3665-x. Epub 2018 Jan 16. PMID: 29340924. [ Links ]

38. Li Y, Stocchi L, Cherla D, Liu X, Remzi FH. Association of Preoperative Narcotic Use with Postoperative Complications and Prolonged Length of Hospital Stay in Patients with Crohn Disease. JAMA Surg. 2016;151(8):726-34. doi: 10.1001/jamasurg.2015.5558. PMID: 26913479. [ Links ]

39. Halaszynski TM, Juda R, Silverman DG. Optimizing postoperative outcomes with efficient preoperative assessment and management. Crit Care Med. 2004;32(4 Suppl):S76-86. doi: 10.1097/01.ccm.0000122046.30687.5c. PMID: 15064666. [ Links ]

40. Kiecolt-Glaser JK, Page GG, Marucha PT, MacCallum RC, Glaser R. Psychological influences on surgical recovery. Perspectives from psychoneuroimmunology. Am Psychol. 1998;53(11):1209- 18. doi: 10.1037/0003-066x.53.11.1209. PMID: 9830373. [ Links ]

41. Gustavo A, Nari GA, Lino Molina L, Florencia Gil F, Lucas Viotto L, José Layún J, Daniela Mariot D, Ariel Arias A, et al. Enhanced Recovery After Surgery (ERAS) en resecciones hepáticas abiertas por metástasis de origen colorrectal. Experiencia inicial. Rev Argent Cirug. 2016;108(1):9-13. [ Links ]

42. van Dijk DPJ, van Woerden V, Cakir H, den Dulk M, Olde Damink SWM, Dejong CHC. ERAS: Improving outcome in the cachectic HPB patient. J Surg Oncol. 2017;116(5):617-22. doi: 10.1002/jso.24767. Epub 2017 Aug 2. PMID: 28767125; PMCID: PMC5697643. [ Links ]

43. Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev. 2003;(4):CD004423. doi: 10.1002/14651858.CD004423. PMID: 14584013. [ Links ]

44. Bilku DK, Dennison AR, Hall TC, Metcalfe MS, Garcea G. Role of preoperative carbohydrate loading: a systematic review. Ann R Coll Surg Engl. 2014;96(1):15-22. doi: 10.1308/003588414X13 824511650614. PMID: 24417824; PMCID: PMC5137663. [ Links ]

45. Thorell A, Nygren J, Ljungqvist O. Insulin resistance: a marker of surgical stress. Curr Opin Clin Nutr Metab Care. 1999;2(1):69- 78. doi: 10.1097/00075197-199901000-00012. PMID: 10453333. [ Links ]

46. Nygren J, Thorell A, Jacobsson H, Larsson S, Schnell PO, Hylén L, Ljungqvist O. Preoperative gastric emptying. Effects of anxiety and oral carbohydrate administration. Ann Surg. 1995;222(6):728-34. doi: 10.1097/00000658-199512000-00006. PMID: 8526579; PMCID: PMC1235021. [ Links ]

47. Ljungqvist O, Thorell A, Gutniak M, Häggmark T, Efendic S. Glucose infusion instead of preoperative fasting reduces postoperative insulin resistance. J Am Coll Surg. 1994;178(4):329-36. PMID: 8149032. [ Links ]

48. Ciacio O, Voron T, Pittau G, Lewin M, Vibert E, Adam R, et al. Interest of preoperative immunonutrition in liver resection for cancer: study protocol of the PROPILS trial, a multicenter randomized controlled phase IV trial. BMC Cancer. 2014;14:980. doi: 10.1186/1471-2407-14-980. PMID: 25523036; PMCID: PMC4302113. [ Links ]

49. Mikagi K, Kawahara R, Kinoshita H, Aoyagi S. Effect of preoperative immunonutrition in patients undergoing hepatectomy; a randomized controlled trial. Kurume Med J. 2011;58(1):1-8. doi: 10.2739/kurumemedj.58.1. PMID: 22027191. [ Links ]

50. Ardito F, Lai Q, Rinninella E, Mimmo A, Vellone M, Panettieri E, et al. The impact of personalized nutritional support on postoperative outcome within the enhanced recovery after surgery (ERAS) program for liver resections: results from the NutriCatt protocol. Updates Surg. 2020;72(3):681-691. doi: 10.1007/s13304-020-00787-6. Epub 2020 May 14. PMID: 32410162. [ Links ]

51. Aloia TA, Geerts WH, Clary BM, Day RW, Hemming AW, D’Albuquerque LC, Vollmer CM Jr, Vauthey JN, Toogood GJ. Venous Thromboembolism Prophylaxis in Liver Surgery. J Gastrointest Surg. 2016;20(1):221-9. doi: 10.1007/s11605-015-2902-4. PMID: 26489742. [ Links ]

52. Day RW, Aloia TA. Enhanced recovery in liver surgery. J Surg Oncol. 2019;119:660‐6. doi.org/10.1002/jso.25420. [ Links ]

53. Lassen K, Coolsen MM, Slim K, Carli F, de Aguilar-Nascimento JE, et al; ERAS^® Society; European Society for Clinical Nutrition and Metabolism; International Association for Surgical Metabolism and Nutrition. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery after Surgery (ERAS^®) Society recommendations. Clin Nutr. 2012;31(6):817- 30. doi: 10.1016/j.clnu.2012.08.011. Epub 2012 Sep 26. PMID: 23079762. [ Links ]

54. Togo S, Tanaka K, Matsuo K, Nagano Y, Ueda M, Morioka D, et al. Duration of antimicrobial prophylaxis in patients undergoing hepatectomy: a prospective randomized controlled trial using flomoxef. J Antimicrob Chemother. 2007;59(5):964-70. doi: 10.1093/jac/dkm028. Epub 2007 Feb 28. PMID: 17329271. [ Links ]

55. Gurusamy KS, Naik P, Davidson BR. Methods of decreasing infection to improve outcomes after liver resections. Cochrane Database Syst Rev . 2011;(11):CD006933. doi: 10.1002/14651858.CD006933.pub2. PMID: 22071832. [ Links ]

56. Holte K, Nielsen KG, Madsen JL, Kehlet H. Physiologic effects of bowel preparation. Dis Colon Rectum. 2004;47(8):1397-402. doi: 10.1007/s10350-004-0592-1. PMID: 15484356. [ Links ]

57. Walker KJ, Smith AF. Premedication for anxiety in adult day surgery. Cochrane Database Syst Rev. 2009;2009(4):CD002192. doi: 10.1002/14651858.CD002192.pub2. PMID: 19821294; PMCID: PMC7098461. [ Links ]

58. Gupta K, Kshirsagar S, Chang L, Schwartz R, Law P-Y, Yee D, Hebbel RP. Morphine Stimulates Angiogenesis by Activating Proangiogenic and Survival-promoting Signaling and Promotes Breast Tumor Growth. Cancer Res. 2002; 62 (15):4491-8. [ Links ]

59. Lennon FE, Mirzapoiazova T, Mambetsariev B, Poroyko VA, Salgia R, Moss J, Singleton PA. The Mu opioid receptor promotes opioid and growth factor-induced proliferation, migration and Epithelial Mesenchymal Transition (EMT) in human lung cancer. PLoS One. 2014;9(3):e91577. doi: 10.1371/journal.pone.0091577. PMID: 24662916; PMCID: PMC3963855. [ Links ]

60. Lillemoe HA, Marcus RK, Day RW, Kim BJ, Narula N, Davis CH, et al. Enhanced recovery in liver surgery decreases postoperative outpatient use of opioids. Surgery. 2019;166(1):22-7. doi: 10.1016/j.surg.2019.02.008. Epub 2019 May 15. PMID: 31103198; PMCID: PMC6579699. [ Links ]

61. Thornblade LW, Seo YD, Kwan T, Cardoso JH, Pan E, Dembo G, et al. Enhanced Recovery via Peripheral Nerve Block for Open Hepatectomy. J Gastrointest Surg. 2018;22(6):981-8. doi: 10.1007/s11605-017-3656-y. Epub 2018 Feb 5. PMID: 29404987; PMCID: PMC5966330. [ Links ]

62. Agarwal V, Divatia JV. Enhanced recovery after surgery in liver resection: current concepts and controversies. Korean J Anesthesiol. 2019;72(2):119-29. doi: 10.4097/kja.d.19.00010. Epub 2019 Mar 6. PMID: 30841029; PMCID: PMC6458514. [ Links ]

63. Grant MC, Sommer PM, He C, Li S, Page AJ, Stone AB, et al. Preserved Analgesia with Reduction in Opioids Through the Use of an Acute Pain Protocol in Enhanced Recovery After Surgery for Open Hepatectomy. Reg Anesth Pain Med. 2017;42(4):451-7. doi: 10.1097/AAP.0000000000000615. PMID: 28525409. [ Links ]

64. Huang HM, Chen RX, Zhu LM, Zhao WS, Ye XJ, Luo JW, et al. Combined use of transversus abdominis plane block and laryngeal mask airway during implementing ERAS programs for patients with primary liver cancer: a randomized controlled trial. Sci Rep. 2020;10(1):14892. doi: 10.1038/s41598-020-71477-x. PMID: 32913210; PMCID: PMC7483533. [ Links ]

65. Agarwal V, Divatia J. Enhanced recovery after surgery in liver resection: current concepts and controversies. Korean J Anaesthesiol. 2019; 72;119-29. [ Links ]

66. Roy JD, Massicotte L, Sassine MP, Seal RF, Roy A. A comparison of intrathecal morphine/fentanyl and patient-controlled analgesia with patient-controlled analgesia alone for analgesia after liver resection. Anesth Analg. 2006;103(4):990-4. doi: 10.1213/01.ane.0000238040.41872.7e. PMID: 17000818. [ Links ]

67. Kasivisvanathan R, Abbassi-Ghadi N, Prout J, Clevenger B, Fusai GK, Mallett SV. A prospective cohort study of intrathecal versus epidural analgesia for patients undergoing hepatic resection. HPB (Oxford). 2014;16(8):768-75. doi: 10.1111/hpb.12222. Epub 2014 Jan 28. PMID: 24467320; PMCID: PMC4113260. [ Links ]

68. Warner SG, Jutric Z, Nisimova L, Fong Y. Early recovery pathway for hepatectomy: data-driven liver resection care and recovery. Hepatobiliary Surg Nutr. 2017;6(5):297-311. doi: 10.21037/hbsn.2017.01.18. PMID: 29152476; PMCID: PMC5673763. [ Links ]

69. Weinberg L, Ianno D, Churilov L, Mcguigan S, Mackley L, Banting J, et al. Goal directed fluid therapy for major liver resection: A multicentre randomized controlled trial. Ann Med Surg (Lond). 2019;45:45-53. doi: 10.1016/j.amsu.2019.07.003. PMID: 31360460; PMCID: PMC6642079. [ Links ]

70. Patel SH, Kim BJ, Tzeng CD, Chun YS, Conrad C, Vauthey JN, Aloia TA. Reduction of Cardiopulmonary/Renal Complications with Serum BNP-Guided Volume Status Management in Posthepatectomy Patients. J Gastrointest Surg. 2018;22(3):467- 76. doi: 10.1007/s11605-017-3600-1. Epub 2017 Oct 11. PMID: 29234998; PMCID: PMC5839990. [ Links ]

71. Correa-Gallego C, Tan KS, Arslan-Carlon V, Gonen M, Denis SC, Langdon-Embry L, et al. Goal-Directed Fluid Therapy Using Stroke Volume Variation for Resuscitation after Low Central Venous Pressure-Assisted Liver Resection: A Randomized Clinical Trial. J Am Coll Surg. 2015;221(2):591-601. doi: 10.1016/j.jamcollsurg.2015.03.050. Epub 2015 Apr 7. PMID: 26206652; PMCID: PMC4926263. [ Links ]

72. Scott EM, Buckland R. A systematic review of intraoperative warming to prevent postoperative complications. AORN J. 2006;83(5):1090-104, 1107-13. doi: 10.1016/s0001-2092(06)60120-8. PMID: 16722286. [ Links ]

73. Wong PF, Kumar S, Bohra A, Whetter D, Leaper DJ. Randomized clinical trial of perioperative systemic warming in major elective abdominal surgery. Br J Surg. 2007;94(4):421-6. doi: 10.1002/bjs.5631. PMID: 17380549. [ Links ]

74. Cheatham ML, Chapman WC, Key SP, Sawyers JL. A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy. Ann Surg. 1995;221(5):469-76; discussion 476-8. doi: 10.1097/00000658-199505000-00004. PMID: 7748028; PMCID: PMC1234620. [ Links ]

75. Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev. 2007;2007(3):CD004929. doi: 10.1002/14651858.CD004929.pub3. PMID: 17636780; PMCID: PMC6669251. [ Links ]

76. Pessaux P, Regimbeau JM, Dondéro F, Plasse M, Mantz J, Belghiti J. Randomized clinical trial evaluating the need for routine nasogastric decompression after elective hepatic resection. Br J Surg. 2007;94(3):297-303. doi: 10.1002/bjs.5728. PMID: 17315273. [ Links ]

77. Basse L, Werner M, Kehlet H. Is urinary drainage necessary during continuous epidural analgesia after colonic resection? Reg Anesth Pain Med. 2000;25(5):498-501. doi: 10.1053/rapm.2000.9537. PMID: 11009235. [ Links ]

78. Mirizzi P-L. La cholécystectomie sans drainage: (Cholécystectomie idéale). Paris: Masson; 1933. Print. [ Links ]

79. Monson JR, Guillou PJ, Keane FB, Tanner WA, Brennan TG. Cholecystectomy is safer without drainage: the results of a prospective, randomized clinical trial. Surgery. 1991;109(6):740- 6. PMID: 2042093. [ Links ]

80. Merad F, Yahchouchi E, Hay JM, Fingerhut A, Laborde Y, Langlois- Zantain O. Prophylactic abdominal drainage after elective colonic resection and suprapromontory anastomosis: a multicenter study controlled by randomization. French Associations for Surgical Research. Arch Surg. 1998;133(3):309-14. doi: 10.1001/archsurg.133.3.309. PMID: 9517746. [ Links ]

81. Belghiti J, Kabbej M, Sauvanet A, Vilgrain V, Panis Y, Fekete F. Drainage after elective hepatic resection. A randomized trial. Ann Surg. 1993;218(6):748-53. doi: 10.1097/00000658-199312000-00008. PMID: 8257225; PMCID: PMC1243070. [ Links ]

82. Franco D, Karaa A, Meakins JL, Borgonovo G, Smadja C, Grange D. Hepatectomy without abdominal drainage. Results of a prospective study in 61 patients. Ann Surg. 1989;210(6):748- 50. doi: 10.1097/00000658-198912000-00009. PMID: 2556083; PMCID: PMC1357866. [ Links ]

83. Wong-Lun-Hing EM, van Woerden V, Lodewick TM, Bemelmans M HA, Olde Damink SWM, et al. Abandoning Prophylactic Abdominal Drainage after Hepatic Surgery: 10 Years of No-Drain Policy in an Enhanced Recovery after Surgery Environment. Dig Surg. 2017;34:411-20. doi: 10.1159/000455246 [ Links ]

84. Kyoden Y, Imamura H, Sano K, Beck Y, Sugawara Y, Kokudo N, Makuuchi M. Value of prophylactic abdominal drainage in 1269 consecutive cases of elective liver resection. J Hepatobiliary Pancreat Sci. 2010;17(2):186-92. doi: 10.1007/s00534-009-0161-z. Epub 2009 Aug 29. PMID: 19727544. [ Links ]

85. Bekki Y, Yamashita Y, Itoh S, Harimoto N, Shirabe K, Maehara Y. Predictors of the Effectiveness of Prophylactic Drains after Hepatic Resection. World J Surg. 2015;39(10):2543-9. doi: 10.1007/s00268-015-3116-3. PMID: 26059409. [ Links ]

86. Burt BM, Brown K, Jarnagin W, DeMatteo R, Blumgart LH, Fong Y. An audit of results of a no-drainage practice policy after hepatectomy. Am J Surg. 2002;184(5):441-5. doi: 10.1016/s0002-9610(02)00998-4. PMID: 12433610. [ Links ]

87. Savikko J, Vikatmaa L, Hiltunen AM, Mallat N, Tukiainen E, Salonen SM, Nordin A. Enhanced recovery protocol in laparoscopic liver surgery. Surg Endosc. 2020; 35(3):1058-66. doi: 10.1007/s00464-020-07470-2. Epub ahead of print. PMID: 32107630. [ Links ]

88. Wong‐Lun‐Hing EM., van Dam RM, van Breukelen GJP, Tanis PJ, Ratti F, van Hillegersberg R, et al Randomized clinical trial of open versus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery after surgery programme (ORANGE II study). BrJ Surg. 2017;104(5):525-35. doi.org/10.1002/bjs.10438. [ Links ]

89. Savikko J, Ilmakunnas M, Mäkisalo H, Nordin A, Isoniemi H. Enhanced recovery protocol after liver resection. Br J Surg. 2015;102(12):1526-32. doi: 10.1002/bjs.9912. Epub 2015 Sep 2. Erratum in: Br J Surg. 2016 Apr;103(5):617. PMID: 26331595. [ Links ]

90. Connor S, Cross A, Sakowska M, Linscott D, Woods J. Effects of introducing an enhanced recovery after surgery programme for patients undergoing open hepatic resection. HPB (Oxford). 2013;15(4):294-301. doi: 10.1111/j.1477-2574.2012.00578.x. Epub 2012 Oct 4. PMID: 23458488; PMCID: PMC3608984. [ Links ]

91. Nari G, Layún J, Mariot D, Viotto L, De Elias ME, López F, et al. (2019). Resultados de la aplicación de un programa Enhanced Recovery (ERP) en resecciones hepáticas abiertas. Rev Argent Cirug. 2019; 111(4):227-35. Disponible en: http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S2250-639X2019000400003&lng=es. [ Links ]

92. Nari GA, Castro-Gutiérrez E, Layún J, Falgueras-Verdaguer L, Mariot D, Albiol-Quer MT, Casellas-Robert M. Open versus laparoscopic hepatectomies within an ERAS (Enhanced Recovery After Surgery) program. Are there differences? Cir Cir. 2020;88(1):49-55. English. doi: 10.24875/CIRU.19000972. PMID: 31967604. [ Links ]

93. Liang X, Ying H, Wang H, Xu H, Yu H, Cai L, et al. Enhanced Recovery Program Versus Traditional Care in Laparoscopic Hepatectomy. Medicine (Baltimore). 2016;95(8):e2835. doi: 10.1097/MD.0000000000002835. PMID: 26937913; PMCID: PMC4779010. [ Links ]

94. Liang X, Ying H, Wang H, Xu H, Liu M, Zhou H, et al. Enhanced recovery care versus traditional care after laparoscopic liver resections: a randomized controlled trial. Surg Endosc. 2018;32(6):2746-57. doi: 10.1007/s00464-017-5973-3. Epub 2017 Dec 12. PMID: 29234943. [ Links ]

95. Ratti F, Fiorentini G, Cipriani F, Catena M, Paganelli M, Aldrighetti L. Laparoscopic vs Open Surgery for Colorectal Liver Metastases. JAMA Surg. 2018;153(11):1028-35. doi: 10.1001/jamasurg.2018.2107. PMID: 30027220; PMCID: PMC6583700. [ Links ]

96. Tsung A, Geller DA, Sukato DC, Sabbaghian S, Tohme S, Steel J, et al. Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg. 2014;259(3):549-55. doi: 10.1097/SLA.0000000000000250. PMID: 24045442. [ Links ]

97. Lassen K, Kjaeve J, Fetveit T, Tranø G, Sigurdsson HK, Horn A, Revhaug A. Allowing normal food at will after major upper gastrointestinal surgery does not increase morbidity: a randomized multicenter trial. Ann Surg. 2008;247(5):721-9. doi: 10.1097/SLA.0b013e31815cca68. PMID: 18438106. [ Links ]

98. Richter B, Schmandra TC, Golling M, Bechstein WO. Nutritional support after open liver resection: a systematic review. Dig Surg. 2006;23(3):139-45. doi: 10.1159/000094345. PMID: 16809912. [ Links ]

99. Hendry PO, van Dam RM, Bukkems SFFW, McKeown DW., Parks RW, Preston T, et al. Randomized clinical trial of laxatives and oral nutritional supplements within an enhanced recovery after surgery protocol following liver resection. Br J Surg. 2010;97:1198-206. https://doi.org/10.1002/bjs.7120 [ Links ]

100. Brower RG. Consequences of bed rest. Crit Care Med. 2009;37(10 Suppl):S422-8. doi: 10.1097/CCM.0b013e3181b6e30a. PMID: 20046130. [ Links ]

101. Ni CY, Wang ZH, Huang ZP, Zhou H, Fu LJ, Cai H, et al. Early enforced mobilization after liver resection: A prospective randomized controlled trial. Int J Surg. 2018;54(Pt A):254-8. doi: 10.1016/j.ijsu.2018.04.060. Epub 2018 May 9. PMID: 29753000. [ Links ]

102. Yip VS, Dunne DF, Samuels S, Tan CY, Lacasia C, Tang J, et al. Adherence to early mobilisation: Key for successful enhanced recovery after liver resection. Eur J Surg Oncol. 2016;42(10):1561-7. doi: 10.1016/j.ejso.2016.07.015. Epub 2016 Aug 3. PMID: 27528466. [ Links ]

103. Noba L, Rodgers S, Chandler C, Balfour A, Hariharan D, Yip VS. Enhanced Recovery After Surgery (ERAS) Reduces Hospital Costs and Improve Clinical Outcomes in Liver Surgery: a Systematic Review and Meta-Analysis. J Gastrointest Surg. 2020;24(4):918- 32. doi: 10.1007/s11605-019-04499-0. Epub 2020 Jan 3. PMID: 31900738; PMCID: PMC7165160. [ Links ]

104. Joliat GR, Hübner M, Roulin D, Demartines N. Cost Analysis of Enhanced Recovery Programs in Colorectal, Pancreatic, and Hepatic Surgery: A Systematic Review. World J Surg. 2020;44(3):647-55. doi: 10.1007/s00268-019-05252-z. PMID: 31664495. [ Links ]

105. St-Amour P, St-Amour P, Joliat GR, Eckert A, Labgaa I, Roulin D, et al. Impact of ERAS compliance on the delay between surgery and adjuvant chemotherapy in hepatobiliary and pancreatic malignancies. Langenbecks Arch Surg. 2020;405(7):959-66. doi: 10.1007/s00423-020-01981-1. Epub 2020 Sep 11. PMID: 32918147; PMCID: PMC7541355. [ Links ]

106. Nari G, Castro Gutiérrez E, Layún J, Falgueras L, Mariot D, et al. There are no advantages between laparoscopic and open liver resections within an Enhanced Recovery Program. Arq Bras Chir Digest. 2021. En prensa. [ Links ]

Received: June 01, 2021; Accepted: July 19, 2021

Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons