Enhanced Recovery After Liver Surgery: Does Compliance Impact Survival?

Area of Science:

• Surgery
• Oncology
• Critical Care Medicine

Background:

• Enhanced recovery programs (ERPs) are known to improve short-term outcomes following liver surgery (LS).
• The impact of ERP compliance on long-term survival after LS remains unclear.
• This study investigates the association between ERP adherence and survival in a large, multicenter liver surgery cohort.

Purpose of the Study:

• To evaluate the association between high Enhanced Recovery Program (ERP) compliance and overall survival (OS) after liver surgery (LS).
• To identify predictors of 12-month and long-term OS in patients undergoing LS.
• To conduct cancer-specific subgroup analyses to explore differential survival impacts.

Main Methods:

• Prospective European multicenter cohort study of adults undergoing elective LS (2016-2024).
• Compliance defined as achieving ≥70% of 21 ERP items.
• 1:1 propensity score matching used to balance baseline characteristics; primary outcome was 12-month OS.

Main Results:

• Among 1860 patients, 24.4% achieved high ERP compliance.
• After propensity score matching (n=874), 12-month OS did not significantly differ between high- and low-compliance groups (96% vs. 92%; p=0.11).
• High ERP compliance was not independently associated with 12-month mortality; long-term mortality linked to metastatic disease and operative factors. Improved survival with high compliance was noted only in colorectal liver metastases subgroup.

Conclusions:

• High ERP compliance is associated with reduced perioperative morbidity after liver surgery.
• ERP compliance is not independently associated with 12-month or long-term overall survival post-liver surgery.
• Specific subgroups, like colorectal liver metastases patients, may experience survival benefits from high ERP compliance.