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Enhanced pathway treatment assists faster recovery post-hepatectomy

Researchers from The University of Texas MD Anderson Cancer Center found that treatment on the Enhanced Recovery in Liver Surgery pathway enabled patients to recover and return to normal life functioning sooner compared with traditional pathway treatment after liver surgery, according to published findings.

“Until now, we have been trying to add up a patient's pain, nausea, and fatigue, but what we really needed to look at is how those symptoms actually impact a patient's life function, because as it turns out, each patient experiences symptoms differently,” Thomas A. Aloia, MD, FACS, associate professor, department of surgical oncology, The University of Texas MD Anderson Cancer Center, Houston, said in a press release. “We found that you could have very symptomatic people who were quite functional, and you could have mildly symptomatic people who were completely disabled.”

Thomas A. Aloia

In a single-center study, Aloia and colleagues evaluated 118 patients undergoing both open and laparoscopic hepatectomy. Data were collected using a patient-reported outcomes tool called the MD Anderson Symptom Inventory (MDASI). The MDASI tool measured symptom severity and life interference preoperatively and postoperatively of every patient at every outpatient visit until 31 days postsurgery.

According to the release, surgeons typically counsel patients and make them aware of the fact they will not feel better for a month after the operation, and that they will not fully recovery until 6 to 8 weeks following surgery. However, in enhanced recovery, a patient’s recovery and return to normal life functions speed up.

“The [Enhanced Recovery in Liver Surgery] protocol included patient education, narcotic-sparing anesthesia and analgesia, rapid diet advancement, restrictive fluid administration, early ambulation and avoidance of drains and tubes,” the researchers wrote.

The researchers sought to compare functional outcomes of 75 patients treated on an Enhanced Recovery in Liver Surgery (ERLS) pathway compared with 43 patients treated on a traditional pathway. All patients were treated simultaneously.

Overall, the patients who underwent ERLS were more likely to report less than 4 out of 10 for an immediate postoperative pain score compared with the traditional pathway patients (76% vs. 56%; P = .023). In addition, the ERLS patients also experienced fewer complications and decreased length of hospitalization (4.8 days vs. 6.1 days; P = .027).

Multivariate analysis showed ERLS pathway treatment was found to be an independent predictor of faster return to baseline interference levels (76% vs. 55%; OR = 2.62; 95% CI, 1.15-5.94).

“The only independent factor that correlated to faster return to baseline functional status, both in terms of absolute value and short time to recovery, was being on an enhanced recovery protocol,” Aloia said in the release. “It wasn't the size of the liver resection, the approach or whether we used an epidural catheter for pain control or not.”

More patients who underwent ERLS pathway were more likely to Return to Intended Oncologic Therapy (RIOT) compared with patients on the traditional pathway (95% vs. 87%), and patients on the ERLS pathway were more likely to also return to RIOT sooner (44.7 days vs. 60.2 days).

“With this study, we may have gotten one step closer to a scientific definition of recovery that could be used in other disease sites,” Aloia said. “As enhanced recovery strategies evolve, we may now have a tool to compare one approach with another to find out which one is better.” – by Melinda Stevens

Disclosures: The research was supported in part by an NIH grant.