Jongkatkorn C, Luvira V, Suwanprinya C, Piampatipan K, Leeratanakachorn N, Tipwaratorn T, Titapun A, Srisuk T, Theeragul S, Jarearnrat A, Thanasukarn V, Pugkhem A, Khuntikeo N, Pairojkul C, Kamsa-Ard S, Bhudhisawasdi V. Compliance with enhanced recovery after surgery predicts long-term outcome after hepatectomy for cholangiocarcinoma. World J Gastrointest Surg 2023; 15(3): 362-373 [PMID: 37032797 DOI: 10.4240/wjgs.v15.i3.362]
Corresponding Author of This Article
Vor Luvira, FRCS (Gen Surg), MD, Associate Professor, Doctor, Surgical Oncologist, Department of Surgery, Faculty of Medicine, Khon Kaen University, Mittraphap Road, Muang Khon Kaen, Khon Kaen 40002, Thailand. vor_110@yahoo.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Chaowasaporn Jongkatkorn, Vor Luvira, Chalisa Suwanprinya, Kantaruthai Piampatipan, Theerawee Tipwaratorn, Attapol Titapun, Tharatip Srisuk, Suapa Theeragul, Apiwat Jarearnrat, Vasin Thanasukarn, Ake Pugkhem, Narong Khuntikeo, Vajarabhongsa Bhudhisawasdi, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
Natwutpong Leeratanakachorn, Department of Surgery, Saraburi Hospital, Saraburi 18000, Thailand
Chawalit Pairojkul, Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
Supot Kamsa-Ard, Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen 40002, Thailand
Author contributions: All the authors contributed to this paper.
Supported bythe grant of Faculty of Medicine, Khon Kaen University, Thailand, No. IN62330.
Institutional review board statement: The Institutional Review Board, Office of Human Research Ethics, Khon Kaen University reviewed and approved this study (No. HE611590).
Informed consent statement: Since this study was a retrospective study, informed consent form is not needed.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at vor_110@yahoo.com.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vor Luvira, FRCS (Gen Surg), MD, Associate Professor, Doctor, Surgical Oncologist, Department of Surgery, Faculty of Medicine, Khon Kaen University, Mittraphap Road, Muang Khon Kaen, Khon Kaen 40002, Thailand. vor_110@yahoo.com
Received: November 18, 2022 Peer-review started: November 18, 2022 First decision: November 30, 2022 Revised: December 9, 2022 Accepted: February 27, 2023 Article in press: February 27, 2023 Published online: March 27, 2023 Processing time: 129 Days and 1.4 Hours
ARTICLE HIGHLIGHTS
Research background
Enhanced recovery after surgery (ERAS) protocol has shown to be beneficial to patient outcomes in various abdominal surgeries, including hepatectomy. However, no previous study has demonstrated this association for hepatectomy in cholangiocarcinoma patients.
Research motivation
The present study explored the ERAS compliance and its association with outcomes of the patients who underwent open liver resection for cholangiocarcinoma during the first period of ERAS implementation.
Research objectives
To demonstrate the association between good ERAS compliance and short-term and long-term outcomes in cholangiocarcinoma patients.
Research methods
Cholangiocarcinoma patients who underwent open hepatectomy between January 2015 and December 2016 were retrospectively analyzed. Patient’s compliance to ERAS was measured by the percentage of ERAS items achieved and categorized into more than and equal to 50% (ERAS ≥ 50), and below 50% (ERAS < 50) of of all ERAS components. Details on operative procedure, patient care, and survival were analyzed.
Research results
A total of 116 patients were identified - 14 patients (12.1%) were categorized into the ERAS ≥ 50 group, and 102 patients were in the ERAS < 50 group. Postoperative hospital stay was significantly shorter in the ERAS ≥ 50 group [8.9 d, 95% confidence interval (CI): 7.3-10.4 d] than in the ERAS < 50 group (13.7 d, 95%CI: 12.2-15.2 d) (P = 0.0217). No hepatobiliary-related complications or in-hospital mortality occurred in the ERAS ≥ 50 group. Overall survival was significantly higher in the ERAS ≥ 50 group.
Research conclusions
Good ERAS compliance is associated with decreased length of hospital stay, decreased morbidity, and better survival.
Research perspectives
Current overall ERAS compliance is poor. Future improvements in ERAS compliance could result in better short-term and long-term outcomes.
