title: Effects of implementing an "enhanced recovery after surgery" program on patients undergoing resection of hepatocellular carcinoma.
abstract: OBJECTIVE
  To evaluate the effects of implementing an "enhanced recovery after surgery" (ERAS) program on the feasibility, safety, and effectiveness of extensive and potentially curative liver resection for hepatocellular carcinoma (HCC).
  
  
  METHODS
  We compared clinicopathologic factors, surgical factors, and outcomes of patients who underwent extended hepatectomy (defined as resection of more than two sections) for HCC, before and after the introduction of an ERAS program.
  
  
  RESULTS
  Operating times and postoperative hospital stay were significantly shorter, and total volume infused during surgery was significantly lower, for the ERAS group than for the control group. Although the ERAS group had a significantly lower percentage of patients with retention of abdominal drainage, this group had a higher frequency of abdominal paracentesis in patients without intraoperative abdominal drainage. Oral dietary intake and the ability to walk steadily resumed significantly earlier in the ERAS group. Postoperative serum concentrations of albumin and cholinesterase were significantly higher in the ERAS group than in the control group.
  
  
  CONCLUSIONS
  The ERAS program was feasible and effective for patients with chronic liver disease undergoing extended liver resection for HCC, because it allowed earlier oral dietary intake and promoted faster postoperative recovery.
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan. kaibori@hirakata.kmu.ac.jp.|Next-generation Minimally Invasive Surgery, Kansai Medical University, Hirakata, Osaka, 573-1191, Japan. kaibori@hirakata.kmu.ac.jp.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kaibori
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Matsui
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan.
authors.forename: Morihiko
authors.initials: M
authors.lastname: Ishizaki
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Iida
authors.affiliation: Department of Medical Statistics, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Yoshii
authors.affiliation: School of Nursing, Kyoto Prefectural University of Medicine, Kyoto, 602-0857, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Asano
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Kon
mesh_terms: D000005:Abdomen; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D004032:Diet / Q000379:methods; D004322:Drainage / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D019152:Paracentesis / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods*; D016896:Treatment Outcome; D016138:Walking
keywords: Enhanced recovery after surgery; Hepatectomy; Liver cancer