Abstract：
The development of laparoscopic liver surgery, the improvement in the perioperative care programs, and the surgical innovation have allowed liver resections on selected cirrhotic patients. However, the great majority of ERAS studies for liver surgery have been conducted on patients with normal liver parenchyma, while its application on cirrhotic patients is limited. The purpose of this study was to evaluate the implementation of an ERAS protocol in cirrhotic patients who underwent liver surgery. We present an analytical observational prospective cohort study, which included all adult patients who underwent a liver resection between December 2017 and December 2019 with an ERAS program. We compare the outcomes in patients cirrhotic (CG)/non-cirrhotic (NCG). A total of 101 patients were included. Thirty of these (29.7%) were patients ≥ 70 cirrhotic. 87% of the both groups had performed > 70% of the ERAS. Oral diet tolerance and mobilization on the first postoperative day were similar in both groups. The hospital stay was similar in both groups (2.9 days/2.99 days). Morbidity and mortality were similar; Clavien I-II (CG: 44% vs NCG: 30%) and Clavien ≥ III (CG: 3% vs NCG: 8%). Hospital re-entry was higher in the NCG. Overall mortality of the study was 1%. ERAS protocol compliance was associated with a decrease in complications (ERAS < 70%: 80% vs ERAS > 90%: 20%; p: 0.02) and decrease in severity of complications in both study groups. The application of the ERAS program in cirrhotic patients who undergo liver surgery is feasible, safe, and reproducible. It allows postoperative complications, mortality, hospital stay, and readmission rates comparable to those in standard patients.
摘要：
腹腔镜肝脏手术的发展,围手术期护理计划的改进，和手术创新已经允许肝切除选定的肝硬化患者。然而,肝脏手术的大部分ERAS研究都是在肝实质正常的患者身上进行的，而其在肝硬化患者中的应用是有限的。这项研究的目的是评估ERAS方案在接受肝脏手术的肝硬化患者中的实施。我们提出了一项分析观察性前瞻性队列研究，其中包括在2017年12月至2019年12月期间接受ERAS项目肝切除术的所有成年患者.我们比较肝硬化（CG）/非肝硬化（NCG）患者的预后。共纳入101例患者。其中30例（29.7％）为≥70例肝硬化患者。两组中87%的人进行了>70%的ERAS。两组术后第一天的口服饮食耐受性和动员相似。两组的住院时间相似（2.9天/2.99天）。发病率和死亡率相似；ClavienI-II（CG：44％vsNCG：30％）和Clavien≥III（CG：3％vsNCG：8％）。在NCG中，重新进入医院的比例更高。该研究的总死亡率为1%。在两个研究组中，ERAS方案的依从性与并发症的减少相关（ERAS<70％：80％vsERAS>90％：20％；p：0.02）和并发症严重程度的降低。ERAS计划在接受肝脏手术的肝硬化患者中的应用是可行的，安全,和可重复的。它允许术后并发症，死亡率,住院,再入院率与标准患者相当。
