Top

Published in:

01-02-2015 | Review Article

Enhanced Recovery After Surgery Protocols for Open Hepatectomy—Physiology, Immunomodulation, and Implementation

Authors: Andrew J. Page, Aslam Ejaz, Gaya Spolverato, Tiffany Zavadsky, Michael C. Grant, Daniel J. Galante, Elizabeth C. Wick, Matthew Weiss, Martin A. Makary, Christopher L. Wu, Timothy M. Pawlik

Published in: Journal of Gastrointestinal Surgery | Issue 2/2015

Abstract

There has been recent interest in enhanced-recovery after surgery (ERAS®) or “fast-track” perioperative protocols in the surgical community. The subspecialty field of colorectal surgery has been the leading adopter of ERAS protocols, with less data available regarding its adoption in hepato-pancreato-biliary surgery. This review focuses on available data pertaining to the application of ERAS to open hepatectomy. We focus on four fundamental variables that impact normal physiology and exacerbate perioperative inflammation: (1) the stress of laparotomy, (2) the use of opioids, (3) blood loss and blood product transfusions, and (4) perioperative fasting. The attenuation of these inflammatory stressors is largely responsible for the improvements in perioperative outcomes due to the implementation of ERAS-based pathways. Collectively, the data suggest that the implementation of ERAS principles should be strongly considered in all patients undergoing hepatectomy.

Gustafsson U, Scott M, Schwenk W, et al. Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS®) society recommendations. World journal of surgery 2013; 37(2): 259–84.PubMedCrossRef

Hayhurst C, Durieux ME. Enteral Hydration Prior to Surgery: The Benefits Are Clear. Anesthesia & Analgesia 2014; 118(6): 1163–4.CrossRef

Aarts M-A, Okrainec A, Glicksman A, Pearsall E, Victor JC, McLeod RS. Adoption of enhanced recovery after surgery (ERAS) strategies for colorectal surgery at academic teaching hospitals and impact on total length of hospital stay. Surgical endoscopy 2012; 26(2): 442–50.PubMedCrossRef

Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clinical nutrition 2010; 29(4): 434–40.PubMedCrossRef

Muller S, Zalunardo MP, Hubner M, Clavien PA, Demartines N. A fast-track program reduces complications and length of hospital stay after open colonic surgery. Gastroenterology 2009; 136(3): 842–7. e1.

Šerclová Z, Dytrych P, Marvan J, et al. Fast-track in open intestinal surgery: prospective randomized study (Clinical Trials Gov Identifier no. NCT00123456). Clinical Nutrition 2009; 28(6): 618–24.PubMedCrossRef

Spanjersberg WR, Reurings J, Keus F, Van Laarhoven C. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev 2011; 2.

Lv L, Shao Y-f, Zhou Y-b. The enhanced recovery after surgery (ERAS) pathway for patients undergoing colorectal surgery: an update of meta-analysis of randomized controlled trials. International journal of colorectal disease 2012; 27(12): 1549–54.

Anderson A, McNaught C, MacFie J, Tring I, Barker P, Mitchell C. Randomized clinical trial of multimodal optimization and standard perioperative surgical care. British journal of surgery 2003; 90(12): 1497–504.PubMedCrossRef

10.

Gatt M, Anderson A, Reddy B, Hayward‐Sampson P, Tring I, MacFie J. Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection. British journal of surgery 2005; 92(11): 1354–62.

11.

Eskicioglu C, Forbes SS, Aarts M-A, Okrainec A, McLeod RS. Enhanced recovery after surgery (ERAS) programs for patients having colorectal surgery: a meta-analysis of randomized trials. Journal of gastrointestinal surgery 2009; 13(12): 2321–9.PubMedCrossRef

12.

Zhuang C-L, Ye X-Z, Zhang X-D, Chen B-C, Yu Z. Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Diseases of the Colon & Rectum 2013; 56(5): 667–78.CrossRef

13.

Page A, Rostad B, Staley CA, et al. Epidural analgesia in hepatic resection. Journal of the American College of Surgeons 2008; 206(6): 1184–92.PubMedCrossRef

14.

Kooby DA, Stockman J, Ben-Porat L, et al. Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Annals of surgery 2003; 237(6): 860.PubMedCentralPubMed

15.

Melendez JA, Arslan V, Fischer ME, et al. Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction. Journal of the American College of Surgeons 1998; 187(6): 620–5.PubMedCrossRef

16.

Chen H, Merchant NB, Didolkar MS. Hepatic resection using intermittent vascular inflow occlusion and low central venous pressure anesthesia improves morbidity and mortality. Journal of gastrointestinal surgery 2000; 4(2): 162–7.PubMedCrossRef

17.

Wong-Lun-Hing E, Lodewick T, Stoot J, et al. A survey in the HPB community on ways to enhance patient recovery. Improving the outcome of liver surgery 2012: 189.

18.

Schultz N, Larsen P, Klarskov B, et al. Evaluation of a fast‐track programme for patients undergoing liver resection. British journal of surgery 2013; 100(1): 138–43.PubMedCrossRef

19.

Van Dam R, Hendry P, Coolsen M, et al. Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection. British Journal of Surgery 2008; 95(8): 969–75.PubMedCrossRef

20.

Jones C, Kelliher L, Dickinson M, et al. Randomized clinical trial on enhanced recovery versus standard care following open liver resection. British Journal of Surgery 2013; 100(8): 1015–24.PubMedCrossRef

21.

Lin D-X, Li X, Ye Q-W, Lin F, Li L-L, Zhang Q-Y. Implementation of a fast-track clinical pathway decreases postoperative length of stay and hospital charges for liver resection. Cell biochemistry and biophysics 2011; 61(2): 413–9.PubMedCentralPubMedCrossRef

22.

Dunne DF, Yip VS, Jones RP, et al. Enhanced recovery in the resection of colorectal liver metastases. Journal of surgical oncology 2014.

23.

Goldfarb Y, Sorski L, Benish M, Levi B, Melamed R, Ben-Eliyahu S. Improving postoperative immune status and resistance to cancer metastasis: a combined perioperative approach of immunostimulation and prevention of excessive surgical stress responses. Annals of surgery 2011; 253(4): 798–810.PubMedCrossRef

24.

Colacchio TA, Yeager MP, Hildebrandt LW. Perioperative immunomodulation in cancer surgery. The American journal of surgery 1994; 167(1): 174–9.CrossRef

25.

Benish M, Bartal I, Goldfarb Y, et al. Perioperative use of β-blockers and COX-2 inhibitors may improve immune competence and reduce the risk of tumor metastasis. Annals of surgical oncology 2008; 15(7): 2042–52.PubMedCrossRef

26.

Wada H, Seki S, Takahashi T, et al. Combined spinal and general anesthesia attenuates liver metastasis by preserving TH1/TH2 cytokine balance. Anesthesiology 2007; 106(3): 499–506.PubMedCrossRef

27.

Greenfeld K, Avraham R, Benish M, et al. Immune suppression while awaiting surgery and following it: dissociations between plasma cytokine levels, their induced production, and NK cell cytotoxicity. Brain, behavior, and immunity 2007; 21(4): 503–13.PubMedCrossRef

28.

Bartal I, Melamed R, Greenfeld K, et al. Immune perturbations in patients along the perioperative period: alterations in cell surface markers and leukocyte subtypes before and after surgery. Brain, behavior, and immunity 2010; 24(3): 376–86.PubMedCrossRef

29.

Bar-Yosef S, Melamed R, Page GG, Shakhar G, Shakhar K, Ben-Eliyahu S. Attenuation of the tumor-promoting effect of surgery by spinal blockade in rats. Anesthesiology 2001; 94(6): 1066–73.PubMedCrossRef

30.

Holmgren L, O’Reilly MS, Folkman J. Dormancy of micrometastases: balanced proliferation and apoptosis in the presence of angiogenesis suppression. Nature medicine 1995; 1(2): 149–53.PubMedCrossRef

31.

Belizon A, Balik E, Feingold DL, et al. Major abdominal surgery increases plasma levels of vascular endothelial growth factor: open more so than minimally invasive methods. Annals of surgery 2006; 244(5): 792.PubMedCentralPubMedCrossRef

32.

Lee J-W, Shahzad MM, Lin YG, et al. Surgical stress promotes tumor growth in ovarian carcinoma. Clinical Cancer Research 2009; 15(8): 2695–702.PubMedCentralPubMedCrossRef

33.

Wang H-L, Ning T, Li M, et al. Effect of endostatin on preventing postoperative progression of distant metastasis in a murine lung cancer model. Tumori 2011; 97(6): 787.PubMed

34.

Folkman J. Role of angiogenesis in tumor growth and metastasis. Seminars in oncology; 2002: Elsevier; 2002. p. 15–8.

35.

Ash SA, Buggy DJ. Does regional anaesthesia and analgesia or opioid analgesia influence recurrence after primary cancer surgery? An update of available evidence. Best Practice & Research Clinical Anaesthesiology 2013; 27(4): 441–56.CrossRef

36.

Page AJ, Kooby DA. Perioperative management of hepatic resection. Journal of gastrointestinal oncology 2012; 3(1): 19–27.PubMedCentralPubMed

37.

Gurusamy KS, Li J, Sharma D, Davidson BR. Cardiopulmonary interventions to decrease blood loss and blood transfusion requirements for liver resection. Cochrane Database Syst Rev 2009; 4.

38.

Tzimas P, Prout J, Papadopoulos G, Mallett S. Epidural anaesthesia and analgesia for liver resection. Anaesthesia 2013; 68(6): 628–35.PubMedCrossRef

39.

Urwin S, Parker M, Griffiths R. General versus regional anaesthesia for hip fracture surgery: a meta-analysis of randomized trials. British journal of anaesthesia 2000; 84(4): 450–5.PubMedCrossRef

40.

Ballantyne JC, Carr DB, Suarez T, et al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesthesia & analgesia 1998; 86(3): 598–612.

41.

Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. Bmj 2000; 321(7275): 1493.PubMedCentralPubMedCrossRef

42.

Pöpping DM, Elia N, Van Aken HK, et al. Impact of epidural analgesia on mortality and morbidity after surgery: systematic review and meta-analysis of randomized controlled trials. Annals of surgery 2014; 259(6): 1056–67.PubMedCrossRef

43.

Conrick-Martin I, Kell MR, Buggy DJ. Meta-analysis of the effect of central neuraxial regional anesthesia compared with general anesthesia on postoperative natural killer T lymphocyte function. Journal of clinical anesthesia 2012; 24(1): 3–7.PubMedCrossRef

44.

Sobel H, Bonorris G. Effect of morphine on rats bearing Walker carcinosarcoma 256. 1962.

45.

Gupta K, Kshirsagar S, Chang L, et al. Morphine stimulates angiogenesis by activating proangiogenic and survival-promoting signaling and promotes breast tumor growth. Cancer Research 2002; 62(15): 4491–8.PubMed

46.

Lennon FE, Moss J, Singleton PA. The μ-opioid receptor in cancer progression: is there a direct effect? Anesthesiology 2012; 116(4): 940–5.PubMedCrossRef

47.

Koodie L, Ramakrishnan S, Roy S. Morphine suppresses tumor angiogenesis through a HIF-1α/p38MAPK pathway. The American journal of pathology 2010; 177(2): 984–97.PubMedCentralPubMedCrossRef

48.

Gach K, Szemraj J, Fichna J, Piestrzeniewicz M, Delbro DS, Janecka A. The Influence of Opioids on Urokinase Plasminogen Activator on Protein and mRNA Level in MCF‐7 Breast Cancer Cell Line. Chemical biology & drug design 2009; 74(4): 390–6.CrossRef

49.

Gach K, Wyrębska A, Fichna J, Janecka A. The role of morphine in regulation of cancer cell growth. Naunyn-Schmiedeberg’s archives of pharmacology 2011; 384(3): 221–30.PubMedCentralPubMedCrossRef

50.

Forget P, Collet V, Lavand’homme P, De Kock M. Does analgesia and condition influence immunity after surgery? Effects of fentanyl, ketamine and clonidine on natural killer activity at different ages. European Journal of Anaesthesiology (EJA) 2010; 27(3): 233–40.CrossRef

51.

Yeager MP, Colacchio TA. Effect of morphine on growth of metastatic colon cancer in vivo. Archives of Surgery 1991; 126(4): 454–6.PubMedCrossRef

52.

Sasamura T, Nakamura S, Iida Y, et al. Morphine analgesia suppresses tumor growth and metastasis in a mouse model of cancer pain produced by orthotopic tumor inoculation. European journal of pharmacology 2002; 441(3): 185–91.PubMedCrossRef

53.

Vlassakov KV, Zinner MJ. Putting the Patient First. Annals of surgery 2014; 259(6): 1070–2.PubMedCrossRef

54.

Holt D, Ma X, Kundu N, Fulton A. Prostaglandin E2 (PGE2) suppresses natural killer cell function primarily through the PGE2 receptor EP4. Cancer Immunology, Immunotherapy 2011; 60(11): 1577–86.PubMedCentralPubMedCrossRef

55.

Heaney A, Buggy D. Can anaesthetic and analgesic techniques affect cancer recurrence or metastasis? British journal of anaesthesia 2012; 109(suppl 1): i17-i28.PubMedCrossRef

56.

Forget P, Bentin C, Machiels J-P, Berlière M, Coulie P, De Kock M. Intraoperative use of ketorolac or diclofenac is associated with improved disease-free survival and overall survival in conservative breast cancer surgery. British journal of anaesthesia 2014: aet464.

57.

Katz SC, Shia J, Liau KH, et al. Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Annals of surgery 2009; 249(4): 617–23.PubMedCrossRef

58.

Shiba H, Ishida Y, Wakiyama S, et al. Negative impact of blood transfusion on recurrence and prognosis of hepatocellular carcinoma after hepatic resection. Journal of Gastrointestinal Surgery 2009; 13(9): 1636–42.PubMedCrossRef

59.

Opelz G, Terasaki PI. Improvement of kidney-graft survival with increased numbers of blood transfusions. New England Journal of Medicine 1978; 299(15): 799–803.PubMedCrossRef

60.

Cata J, Wang H, Gottumukkala V, Reuben J, Sessler D. Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions. British journal of anaesthesia 2013; 110(5): 690–701.PubMedCentralPubMedCrossRef

61.

van Twuyver E, Mooijaart RJ, ten Berge IJ, et al. Pretransplantation blood transfusion revisited. New England Journal of Medicine 1991; 325(17): 1210–3.PubMedCrossRef

62.

Jensen L, Andersen A, Christiansen P, et al. Postoperative infection and natural killer cell function following blood transfusion in patients undergoing elective colorectal surgery. British Journal of Surgery 1992; 79(6): 513–6.PubMedCrossRef

63.

Tartter PI. The association of perioperative blood transfusion with colorectal cancer recurrence. Annals of surgery 1992; 216(6): 633.PubMedCentralPubMedCrossRef

64.

Heiss MM, Mempel W, Delanoff C, et al. Blood transfusion-modulated tumor recurrence: first results of a randomized study of autologous versus allogeneic blood transfusion in colorectal cancer surgery. Journal of clinical oncology 1994; 12(9): 1859–67.PubMed

65.

Busch O, Hop W, van Papendrecht MH, Marquet RL, Jeekel J. Blood transfusions and prognosis in colorectal cancer. New England Journal of Medicine 1993; 328(19): 1372–6.PubMedCrossRef

66.

Acheson AG, Brookes MJ, Spahn DR. Effects of allogeneic red blood cell transfusions on clinical outcomes in patients undergoing colorectal cancer surgery: a systematic review and meta-analysis. Annals of surgery 2012; 256(2): 235–44.PubMedCrossRef

67.

Luan H, Ye F, Wu L, Zhou Y, Jiang J. Perioperative blood transfusion adversely affects prognosis after resection of lung cancer: a systematic review and a meta-analysis. BMC surgery 2014; 14(1): 34.PubMedCentralPubMedCrossRef

68.

Wang C-C, Iyer SG, Low JK, et al. Perioperative factors affecting long-term outcomes of 473 consecutive patients undergoing hepatectomy for hepatocellular carcinoma. Annals of surgical oncology 2009; 16(7): 1832–42.PubMedCrossRef

69.

Amato A, Pescatori M. Perioperative blood transfusions for the recurrence of colorectal cancer. Cochrane Database Syst Rev 2006; 1.

70.

Kneuertz PJ, Patel SH, Chu CK, et al. Effects of perioperative red blood cell transfusion on disease recurrence and survival after pancreaticoduodenectomy for ductal adenocarcinoma. Annals of surgical oncology 2011; 18(5): 1327–34.PubMedCrossRef

71.

Awad S, Varadhan KK, Ljungqvist O, Lobo DN. A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery. Clinical Nutrition 2013; 32(1): 34–44.PubMedCrossRef

72.

Maltby JR, Sutherland A, Sale J, Shaffer E. Preoperative oral fluids: is a five-hour fast justified prior to elective surgery? Anesthesia & Analgesia 1986; 65(11): 1112–6.CrossRef

73.

Gjessing PF. Postoperative insulin resistance and the metabolic and cellular responses to single-dose preoperative oral carbohydrate supplementation–Experimental studies in pigs. 2014.

74.

Ljungqvist O, Nygren J, Thorell A. Modulation of post-operative insulin resistance by pre-operative carbohydrate loading. Proceedings of the Nutrition Society 2002; 61(03): 329–36.PubMedCrossRef

75.

Soop M, Nygren J, Myrenfors P, Thorell A, Ljungqvist O. Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance. American Journal of Physiology-Endocrinology And Metabolism 2001; 280(4): E576-E83.PubMed

76.

Hausel J, Nygren J, Lagerkranser M, et al. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Anesthesia & Analgesia 2001; 93(5): 1344–50.CrossRef

77.

Eshuis WJ, Hermanides J, van Dalen JW, et al. Early postoperative hyperglycemia is associated with postoperative complications after pancreatoduodenectomy. Annals of surgery 2011; 253(4): 739–44.PubMedCrossRef

78.

Desai SP, Henry LL, Holmes SD, et al. Strict versus liberal target range for perioperative glucose in patients undergoing coronary artery bypass grafting: a prospective randomized controlled trial. The Journal of thoracic and cardiovascular surgery 2012; 143(2): 318–25.PubMedCrossRef

79.

King JT, Goulet JL, Perkal MF, Rosenthal RA. Glycemic control and infections in patients with diabetes undergoing noncardiac surgery. Annals of surgery 2011; 253(1): 158–65.PubMedCrossRef

80.

Kiran RP, Turina M, Hammel J, Fazio V. The clinical significance of an elevated postoperative glucose value in nondiabetic patients after colorectal surgery: evidence for the need for tight glucose control? Annals of surgery 2013; 258(4): 599–605.PubMed

81.

Kwon S, Thompson R, Dellinger P, Yanez D, Farrohki E, Flum D. Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Annals of surgery 2013; 257(1): 8–14.PubMedCentralPubMedCrossRef

82.

Turina M, Miller FN, Tucker CF, Polk HC. Short-term hyperglycemia in surgical patients and a study of related cellular mechanisms. Annals of surgery 2006; 243(6): 845.PubMedCentralPubMedCrossRef

83.

Turina M, Fry DE, Polk Jr HC. Acute hyperglycemia and the innate immune system: clinical, cellular, and molecular aspects. Critical care medicine 2005; 33(7): 1624–33.PubMedCrossRef

84.

Viganò J, Cereda E, Caccialanza R, et al. Effects of preoperative oral carbohydrate supplementation on postoperative metabolic stress response of patients undergoing elective abdominal surgery. World journal of surgery 2012; 36(8): 1738–43.PubMedCrossRef

85.

Kurosawa S. Anesthesia in patients with cancer disorders. Current Opinion in Anesthesiology 2012; 25(3): 376–84.PubMedCrossRef

86.

Wang Z, Wang Q, Wang W, Qin H. Randomized clinical trial to compare the effects of preoperative oral carbohydrate versus placebo on insulin resistance after colorectal surgery. British Journal of Surgery 2010; 97(3): 317–27.PubMedCrossRef

87.

Wong-Lun-Hing E, van Dam R, Heijnen L, et al. Is Current Perioperative Practice in Hepatic Surgery Based on Enhanced Recovery After Surgery (ERAS) Principles? World journal of surgery 2014: 1–14.

88.

Hughes MJ, McNally S, Wigmore SJ. Enhanced recovery following liver surgery: a systematic review and meta‐analysis. HPB 2014.

89.

Ni C, Yang Y, Chang Y, et al. Fast-track surgery improves postoperative recovery in patients undergoing partial hepatectomy for primary liver cancer: A prospective randomized controlled trial. European Journal of Surgical Oncology (EJSO) 2013; 39(6): 542–7.CrossRef

90.

Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI. Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis? Anesthesiology 2006; 105(4): 660.PubMedCentralPubMedCrossRef

91.

Biki B, Mascha E, Moriarty DC, Fitzpatrick JM, Sessler DI, Buggy DJ. Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis. Anesthesiology 2008; 109(2): 180–7.PubMedCrossRef

92.

Wuethrich PY, Schmitz S-FH, Kessler TM, et al. Potential influence of the anesthetic technique used during open radical prostatectomy on prostate cancer-related outcome: a retrospective study. Anesthesiology 2010; 113(3): 570–6.PubMed

93.

Gottschalk A, Ford JG, Regelin CC, et al. Association between epidural analgesia and cancer recurrence after colorectal cancer surgery. Anesthesiology 2010; 113(1): 27–34.PubMedCrossRef

94.

Gupta A, Björnsson A, Fredriksson M, Hallböök O, Eintrei C. Reduction in mortality after epidural anaesthesia and analgesia in patients undergoing rectal but not colonic cancer surgery: a retrospective analysis of data from 655 patients in central Sweden. British journal of anaesthesia 2011; 107(2): 164–70.PubMedCrossRef

95.

Lin L, Liu C, Tan H, Ouyang H, Zhang Y, Zeng W. Anaesthetic technique may affect prognosis for ovarian serous adenocarcinoma: a retrospective analysis. British journal of anaesthesia 2011; 106(6): 814–22.PubMedCrossRef

96.

de Oliveira Jr GS, Ahmad S, Schink JC, Singh DK, Fitzgerald PC, McCarthy RJ. Intraoperative neuraxial anesthesia but not postoperative neuraxial analgesia is associated with increased relapse-free survival in ovarian cancer patients after primary cytoreductive surgery. Regional anesthesia and pain medicine 2011; 36(3): 271–7.CrossRef

97.

Tsui BC, Rashiq S, Schopflocher D, et al. Epidural anesthesia and cancer recurrence rates after radical prostatectomy. Canadian Journal of Anesthesia/Journal canadien d’anesthésie 2010; 57(2): 107–12.CrossRef

98.

Myles PS, Peyton P, Silbert B, Hunt J, Rigg JR, Sessler DI. Perioperative epidural analgesia for major abdominal surgery for cancer and recurrence-free survival: randomised trial. BMJ 2011; 342.

99.

Cummings III KC, Xu F, Cummings LC, Cooper GS. A comparison of epidural analgesia and traditional pain management effects on survival and cancer recurrence after colectomy: a population-based study. Anesthesiology 2012; 116(4): 797–806.PubMedCrossRef

100.

Christopherson R, James KE, Tableman M, Marshall P, Johnson FE. Long-term survival after colon cancer surgery: a variation associated with choice of anesthesia. Anesthesia and analgesia 2008; 107(1): 325–32.PubMedCrossRef

Title: Enhanced Recovery After Surgery Protocols for Open Hepatectomy—Physiology, Immunomodulation, and Implementation
Authors: Andrew J. Page
Aslam Ejaz
Gaya Spolverato
Tiffany Zavadsky
Michael C. Grant
Daniel J. Galante
Elizabeth C. Wick
Matthew Weiss
Martin A. Makary
Christopher L. Wu
Timothy M. Pawlik
Publication date: 01-02-2015
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 2/2015
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-014-2712-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Enhanced Recovery After Surgery Protocols for Open Hepatectomy—Physiology, Immunomodulation, and Implementation

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2015

Current Recommendations for Surveillance and Surgery of Intraductal Papillary Mucinous Neoplasms May Overlook Some Patients with Cancer

Estimates of Conditional Survival in Gastric Cancer Reveal a Reduction of Racial Disparities with Long-Term Follow-Up

Risk Factors for 30-day Readmissions after Hepatectomy: Analysis of 2444 Patients from the ACS-NSQIP Database

Can the Risk of Non-home Discharge After Resection of Gastric Adenocarcinoma Be Predicted: a Seven-Institution Study of the US Gastric Cancer Collaborative

Usefulness of Laparoscopic Side-to-Side Duodenojejunostomy for Gastrointestinal Stromal Tumors Located at the Duodenojejunal Junction

Clinical Outcomes and Costs Associated with In-hospital Biliary Complications After Liver Transplantation: a Cross-Sectional Analysis