Greater compliance with enhanced recovery after surgery (ERAS) protocols was associated with lower incidence of major postoperative complications and shorter hospital stay for patients undergoing hepatic resection for primary liver cancer (PLC). These findings were published in the Journal of Cancer Research and Clinical Oncology.

ERAS programs comprise evidence-based multimodal care aimed at reducing perioperative stress, iatrogenic infection, gut dysfunction, and postoperative pain. Although such programs have been shown to be beneficial for patients, protocols and practices vary. For this prospective, single-center cohort study, 436 patients with PLC undergoing hepatic resection at the West China Hospital between 2019 and 2020 were evaluated for ERAS compliance and 30-day outcomes.

The ERAS protocol for this study had 20 components. Good compliance was defined as 75% or greater compliance with 15 components.

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The study cohort was 68.35% men, median age 54 years (IQR, 47 to 66); 381 patients had hepatocellular carcinoma and 55 had intrahepatic cholangiocarcinoma.

A total of 206 patients were ERAS compliant. Stratified by ERAS component, 14 components had compliance rates of 70% or greater.

The components patients were most compliant with included preoperative counseling and education, antimicrobial prophylaxis, and avoiding nasogastric tubes (greater than 95% for each); compliance was lowest for intraoperative hypothermia, postoperative nutritional screening, fluid balance during the first 24 hours after surgery, and antithrombotic prophylaxis (range, 30% to 40%).

Stratified by compliance, those with higher compliance rates experienced lower rates of major complications (odds ratio [OR], 0.449; P =.012), pneumonia (OR, 0.306; P =.030), and shorter hospital stay (5 vs 6 days; P <.001).

This study was limited by its short follow-up duration.

Compliance with the ERAS program was found to decrease risk for major complications and reduce hospital stay following hepatic resection for PLC, supporting widespread adoption of ERAS programs.


Feng J, Li K, Xu R, et al. Association between compliance with enhanced recovery after surgery (ERAS) protocols and postoperative outcome in patients with primary liver cancer undergoing hepatic resection. J Cancer Res Clin Oncol. Published online January 25, 2022. doi:10.1007/s00432-021-03891-1