Enhanced recovery program after OPEN and laparoscopic liver resection: may IT enhace the advantages offered by the minimally invasive approach?

Introduction: the present study aimed to determine and compare the impact of enhanced recovery program (ERP) after open and laparoscopic liver resection.Methods: four standardized perioperative care pathways were developed and implemented in patients undergoing liver resection (major open or laparoscopic, minor open or laparoscopic). Perioperative outcomes were compared between the groups of patients operated before and after the introduction of the ERP.Results: between December 2008 and December 2016, 787 patients underwent liver resection. Open resection were 315 (40%) and 472 (60%) Laparoscopic. In the open group, hospital stay (LOS) stay was significantly shorter in the ERP group (142 patients) when compared to the control group (173 patients) (median 6, IQ 5 to 8 and 7, IQ 6 to 12 days, respectively, p=0.05). Patients undergoing ERP minimal invasive liver resection (233 patients) had similar LOS compared with the control group (239 patients) (3 IQ 2 to 4 versus 3 IQ 2 to 4 days, p 0.69). Clavien-Dindo > Grade II complications were significantly (p< 0.0001) lower and no 90-day mortality was observed in both open and Laparoscopic ERP groups.Conclusion(s): the impact of ERP on patients undergoing liver resections has not been clarified yet, especially when considering the expansion of laparoscopic liver surgery. In our experience ERP reduced LOS after open liver resection, although after laparoscopic liver resection LOS was similar. However the minor rate of major complications, such as have been equally witnessed in both groups suggests ERP may further enhance the advantages of the laparoscopic approach