Enhanced recovery after surgery protocols for open hepatectomy--physiology, immunomodulation, and implementation

Area of Science:

• Surgical Innovation
• Perioperative Medicine
• Gastrointestinal Surgery

Background:

• Enhanced recovery after surgery (ERAS) protocols are increasingly adopted in surgery.
• Colorectal surgery has led ERAS implementation, with less data in hepato-pancreato-biliary (HPB) surgery.
• This review examines ERAS application in open hepatectomy.

Purpose of the Study:

• To review the available data on ERAS protocols for open hepatectomy.
• To identify key physiological stressors and their impact on perioperative inflammation.
• To assess the benefits of ERAS in improving outcomes for hepatectomy patients.

Main Methods:

• Literature review of studies on ERAS protocols in open hepatectomy.
• Focus on four key perioperative variables: surgical stress, opioid use, blood loss, and fasting.
• Analysis of how attenuating these stressors impacts patient recovery.

Main Results:

• ERAS protocols aim to reduce perioperative inflammation by managing key stressors.
• Improvements in perioperative outcomes are linked to the attenuation of these inflammatory triggers.
• Data suggests ERAS principles are beneficial for patients undergoing open hepatectomy.

Conclusions:

• ERAS principles effectively mitigate perioperative inflammation and improve outcomes in open hepatectomy.
• Implementation of ERAS pathways should be strongly considered for all hepatectomy patients.
• Further research into HPB surgery adoption of ERAS is warranted.