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Publications

Journal Article Ahead of print 1 citation

PubMed: 41926013 DOI: 10.1245/s10434-026-19459-7

Enhanced Recovery After Liver Surgery: Does Compliance Impact Survival?

Ann Surg Oncol

Authors: Martina Mariatti, Francesca Venza, Alessandra Cristaudi, Lorenzo Bernardi, Isabella Hunjan, Paul Boulard, Fabrice Muscari, Eddy Cotte, Guillaume Passot, Pascale Mariani, Rabih-Tany Mikhael, Olivier Detry, Gabriel Thierry, Benjamin Muller, Olivier Facy, Aurélien Dupre, Nicolas Mouton, David-Jérémie Birnbaum, Théophile Guilbaud, Giuliana Amaddeo, Paul Vigneron, Daniele Sommacale, Karem Slim, Alexandre Doussot, Raffaele Brustia

Affiliations

  • INSERM U955, Team ''Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers'', Créteil, France.
  • Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, GRCT OPTIMA, Créteil, France.
  • Paris Est Créteil University, UPEC, Créteil, France.
  • Digestive Surgical Oncology - Liver Transplantation Unit, National Referral Center-Echninococcosis. CNR-E, CHU Besancon, France, CHU Besancon, France.
  • Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Ente Ospedaliero Cantonale and Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland.
  • Digestive Surgery and Transplantation Department, Toulouse University Hospital Centre, Toulouse, France.
  • Service de chirurgie digestive et oncologique, Hôpital Lyon-Sud - CHU de Lyon, Lyon, France.
  • Department of Surgical Oncology, Institut Curie, PSL Research University, Paris, France.
  • Department of Abdominal Surgery and Transplantation, CHU Liege, University of Liege (CHU ULg), Liege, Belgium.
  • Department of Anesthesia and Intensive Care Medicine, CHU Liege, University of Liege (CHU-ULg), Liege, Belgium.
  • Digestive, Endocrine and Cancer Surgery Department, CHU Dijon, Dijon, France.
  • Department of Surgical Oncology, Inserm, U1032, LabTau, Lyon, Centre Léon Bérard, Lyon, France.
  • Univ Lyon, Lyon, France.
  • Digestive and Oncological Surgery Unit, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Faculté de Médecine de Marseille, Aix-Marseille Université, Marseille, France.
  • Department of Hepatology, AP-HP, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.
  • Pôle Santé République (ELSAN Group), Clermont-Ferrand, France.
  • Francophone Group for Enhanced Recovery After Surgery (GRACE), Beaumont, France.
  • INSERM U955, Team ''Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers'', Créteil, France.
  • Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, GRCT OPTIMA, Créteil, France.
  • Paris Est Créteil University, UPEC, Créteil, France.

Abstract

BACKGROUND

Enhanced recovery programs (ERPs) improve short-term outcomes after liver surgery (LS), but their impact on survival remains uncertain. This study evaluated the association between ERP compliance and survival in a large multicenter cohort.

METHODS

This prospective European multicenter cohort included adults undergoing elective LS between 2016 and 2024 in 10 centers implementing Enhanced Recovery After Surgery (ERAS)-consistent ERPs. Compliance was defined as the proportion of 21 fulfilled items with high compliance (≥70%). A 1:1 propensity score-matching was performed to balance baseline characteristics. The primary outcome was 12 month overall survival (OS). Secondary outcomes included predictors of 12 month and long-term OS and cancer-specific subgroup analyses. Cox regression models, Kaplan-Meier analyses, and sensitivity analyses including center effects were used.

RESULTS

Among 1860 patients, 453 (24.4%) achieved high ERP compliance. After matching, 437 well-balanced pairs (n = 874) were analyzed. The 12-month OS did not differ significantly between the high- and low-compliance groups before (95% vs. 92%; p = 0.081) or after (96% vs. 92%; p = 0.11) matching. In the matched cohort, high ERP compliance was not independently associated with 12 month mortality (adjusted hazard ratio, 0.68; 95% confidence interval, 0.36-1.30; p = 0.20). Long-term mortality was independently associated with metastatic disease, operative duration longer than180 min, and intraoperative hypotension. In subgroup analyses after matching, improved survival with high compliance was observed only for patients with colorectal liver metastases (p = 0.029).

CONCLUSION

High ERP compliance reduces perioperative morbidity but is not independently associated with 12 month or long-term survival after LS.

MeSH

Mortality, Recycling, Liver