title: Impact of ERAS approach and minimally-invasive techniques on outcome of patients undergoing liver surgery for hepatocellular carcinoma.
abstract: OBJECTIVE
  Aim of the study was to assess the impact of ERAS approach ("fluid restrictive and drainless") on open liver resections for HCC comparing their outcome with open resections in pre-ERAS period and with laparoscopic surgery.
  
  
  METHODS
  207 patients undergoing minor liver resection for HCC were divided into three groups: Group A, open minor resections in pre-ERAS period (95 patients); Group B, laparoscopic ERAS resections (55 patients); Group C, open ERAS resections (57 patients).
  
  
  RESULTS
  Blood loss was lower in group C and B compared with group A. Postoperative morbidity was 26.5% in group A, 16.3% in group B and 12.1% in group C (p<0.05). Ascites was less frequent in group B (7.5%) and C (6.2%) compared with group A (12%). Median time for functional recovery in group B (3 days) and C (3 days) was shorter compared with group A (5 days).
  
  
  CONCLUSIONS
  Laparoscopic approach confirms to be associated with reduced blood loss and postoperative morbidity. In patients who cannot be candidates to minimally-invasive approach, ERAS management seems to allow blood loss and postoperative morbidity reduction: indeed, results achieved in this group of patients are more similar to those of laparoscopy than to pre-ERAS open surgery.
authors: Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy. Electronic address: ratti.francesca@hsr.it.
authors: Francesca
authors: F
authors: Ratti
authors: Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy.
authors: Federica
authors: F
authors: Cipriani
authors: Department of Anaesthesiology and Intensive Care, IRCCS San Raffaele Hospital, Milano, Italy.
authors: Raffaella
authors: R
authors: Reineke
authors: Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy.
authors: Marco
authors: M
authors: Catena
authors: Department of Anaesthesiology and Intensive Care, IRCCS San Raffaele Hospital, Milano, Italy.
authors: Laura
authors: L
authors: Comotti
authors: Department of Anaesthesiology and Intensive Care, IRCCS San Raffaele Hospital, Milano, Italy.
authors: Luigi
authors: L
authors: Beretta
authors: Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy.
authors: Luca
authors: L
authors: Aldrighetti
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D017093:Liver Failure / Q000453:epidemiology / Q000209:etiology; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome
keywords: ERAS; Fast track; Hepatocellular carcinoma; Laparoscopy; Liver failure; Liver surgery