Fast track program in liver resection: a PRISMA-compliant systematic review and meta-analysis

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Gastroenterology

Background:

• The Enhanced Recovery After Surgery (ERAS) program, a multimodal approach, enhances postoperative rehabilitation and recovery.
• Initially developed for cardiac surgery, it has been adapted for colorectal and liver resections.
• Despite its acceptance, ERAS is not yet standard care in liver surgery.

Purpose of the Study:

• To systematically review and meta-analyze the impact of the ERAS program versus traditional care (TC) on clinical and surgical outcomes.
• To evaluate outcomes in patients undergoing elective liver resection.

Main Methods:

• A systematic search of PubMed/Medline, Scopus, and Cochran databases was conducted.
• Included studies compared ERAS with TC in elective liver resection.
• Subgroup analysis for laparoscopic and open approaches was performed; quality assessment and meta-analysis using Odds Ratios and Mean Differences were employed.

Main Results:

• The ERAS program significantly shortened length of hospital stay (LoS) in both open and laparoscopic liver resections.
• Accelerated functional recovery, decreased hospital costs, reduced operative time, and lower ICU admission rates were observed.
• No increase in readmission, morbidity, or mortality rates was found with the ERAS program.

Conclusions:

• The ERAS program is safe, feasible, and successfully applicable in liver resection.
• Further RCTs are recommended for issues like multimodal analgesia and adherence.
• Development of specific ERAS guidelines for liver resection is needed.