Application of “LEER” mode accelerated rehabilitation surgery concept in laparoscopic anatomical hepatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIE Qingyun ¹ ,  LEI Zehua ¹ , GAO Fengwei ¹ , YANG Jie ¹ , LU Heng ² , JIANG Kangyi ¹ , GONG Jie ¹ , ZHAO Xin ¹ , XUE Qian ¹

1. Department of Hepatobiliary Pancreatic Splenic Surgery, Leshan People's Hospital of Sichuan Province, Diagnosis and Treatment Center of Hepatobiliary Pancreatic Splenic Systemic Disease in Leshan, and The Second Batch of Hepatobiliary and Pancreatic ERAS standard wards of Hubei Chen Xiaoping Science and Technology Development Foundation, Leshan, Sichuan 614000, P. R. China;
2. Department of Surgery and Anesthesia, Leshan people's Hospital, Leshan, Sichuan 614000, P. R. China;

Corresponding?author：

LEI Zehua, Email: leisehua@126.com

Keywords：

“LEER” model; enhanced recovery after surgery; primary liver cancer; laparoscopy; anatomical hepatectomy

DOI：

10.7507/1007-9424.202006063

Video：

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Objective To explore the clinical value and experience of enhanced recovery after surgery (ERAS) of “LEER” model with “less pain” “early move” “early eat” and “reassuring” as its ultimate goal in perioperative period of laparoscopic anatomical hepatectomy of patients with primary liver cancer.Methods The basic clinical data of 98 patients treated in our department from May 2017 to March 2020 who were diagnosed as primary liver cancer and underwent laparoscopic anatomical hepatectomy were retrospectively analyzed. The incidence of postoperative complications, postoperative recovery and patients’ satisfaction were compared between 40 patients managed with traditional model (traditional group) and 58 patients managed with measures of ERAS of “LEER” model (“LEER”-ERAS group).Results Compared with the traditional group, the “LEER”-ERAS group had lower postoperative pain scores (t=2.925, P=0.004), earlier postoperative anal exhaustion, bowel movement and normal diet (t=3.071, t=3.770, t=3.232, all P<0.005) , shorter time to postoperative off-bed activity (t=5.025, P<0.001) and earlier postoperative removal time of drainage tube (t=3.232, P=0.001). Postoperative hospital stay was shorter (t=4.831, P<0.001), the cost of hospitalization was lower (t=3.062, P=0.003), and the patient’s satisfaction with medical treatment was higher (χ²=9.267, P=0.002). There were no statistical difference in the operative time, intraoperative blood loss, rate of conversion to laparotomy, blocking time of porta hepatis, postoperative complications and postoperative adverse events between the two groups (P>0.05).Conclusions Compared with the traditional model, the measures of ERAS of “LEER” model that applied to laparoscopic anatomical hepatectomy of patients with primary liver cancer, is safe and effective, and can relieve postoperative pain, accelerate postoperative rehabilitation, improve satisfaction of patients, shorten hospital stay, and reduce medical costs. It has further promotion and research value.

Citation： XIE Qingyun, LEI Zehua, GAO Fengwei, YANG Jie, LU Heng, JIANG Kangyi, GONG Jie, ZHAO Xin, XUE Qian. Application of “LEER” mode accelerated rehabilitation surgery concept in laparoscopic anatomical hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(3): 322-328. doi: 10.7507/1007-9424.202006063 Copy

1.	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
2.	Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr, 2005, 24(3): 466-477.
3.	Basse L, Hjort Jakobsen D, Billesb?lle P, et al. A clinical pathway to accelerate recovery after colonic resection. Ann Surg, 2000, 232(1): 51-57.
4.	Melnyk M, Casey RG, Black P, et al. Enhanced recovery after surgery (ERAS) protocols: time to change practice? Can Urol Assoc J, 2011, 5(5): 342-348.
5.	黎介壽. 對Fast-track Surgery (快通道外科)內涵的認識. 中華醫學雜志, 2007, 87(8): 515-517.
6.	江志偉, 黎介壽, 汪志明, 等. 胃癌患者應用加速康復外科治療的安全性及有效性研究. 中華外科雜志, 2007, 45(19): 1314-1317.
7.	江志偉, 黎介壽, 汪志明, 等. 加速康復外科用于直腸癌前切除病人價值探討. 中國實用外科雜志, 2008, 28(1): 59-61.
8.	黎介壽, 江志偉. 加速康復外科的臨床意義不僅僅是縮短住院日. 中華消化外科雜志, 2015, 14(1): 22-24.
9.	Varadhan KK, Neal KR, Dejong CH, et al. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr, 2010, 29(4): 434-440.
10.	童衛東. 結直腸外科圍手術期處理的革命性進展—加速康復外科理念. 國際外科學雜志, 2011, 38(8): 508-510.
11.	陳孝平. “兩減一保” —中國醫生早年對病人加速康復的認識與實踐. 腹部外科, 2017, 30(2): 73-74.
12.	陳凜, 陳亞進, 董海龍, 等. 加速康復外科中國專家共識及路徑管理指南(2018版). 中國實用外科雜志, 2018, 38(1): 1-20.
13.	Abeles A, Kwasnicki RM, Darzi A. Enhanced recovery after surgery: Current research insights and future direction. World J Gastrointest Surg, 2017, 9(2): 37-45.
14.	雷澤華, 謝青云, 趙欣, 等. “LEER”模式加速康復外科理念在胰十二指腸切除術中的應用. 肝膽胰外科雜志, 2020, 32(3): 138-142.
15.	van Dam RM, Hendry PO, Coolsen MM, et al. Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection. Br J Surg, 2008, 95(8): 969-975.
16.	Koea JB, Young Y, Gunn K. Fast track liver resection: the effect of a comprehensive care package and analgesia with single dose intrathecal morphine with gabapentin or continuous epidural analgesia. HPB Surg, 2009, 2009: 271986.
17.	Savikko J, Ilmakunnas M, M?kisalo H, et al. Enhanced recovery protocol after liver resection. Br J Surg, 2015, 102(12): 1526-1532.
18.	Qi S, Chen G, Cao P, et al. Safety and efficacy of enhanced recovery after surgery (ERAS) programs in patients undergoing hepatectomy: a prospective randomized controlled trial. J Clin Lab Anal, 2018, 32(6): e22434.
19.	Zhao Y, Qin H, Wu Y, et al. Enhanced recovery after surgery program reduces length of hospital stay and complications in liver resection: a PRISMA-compliant systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore), 2017, 96(31): e7628.
20.	韓冰, 丁義濤, 朱新華, 等. 加速康復外科理念在腹腔鏡肝切除術中的應用. 臨床肝膽病雜志, 2018, (3): 567-572.
21.	駱鵬飛, 莢衛東, 許戈良, 等. 加速康復外科理念在原發性肝癌患者肝切除圍手術期中的應用. 中華普通外科雜志, 2015, 30(11): 862-865.
22.	Sánchez-Pérez B, Aranda-Narváez JM, Suárez-Mu?oz MA, et al. Fast-track program in laparoscopic liver surgery: Theory or fact? World J Gastrointest Surg, 2012, 4(11): 246-250.
23.	朱斌, 黃建宏. 加速康復外科在我國發展現狀、挑戰與對策. 中國實用外科雜志, 2017, 37(1): 26-27.
24.	Visioni A, Shah R, Gabriel E, et al. Enhanced recovery after surgery for noncolorectal surgery?: a systematic review and meta-analysis of major abdominal surgery. Ann Surg, 2018, 267(1): 57-65.
25.	姜洪池, 李丹. 實施加速康復外科若干問題思考. 中國實用外科雜志, 2017, 37(1): 1-4.
26.	Sibbern T, Bull Sellevold V, Steindal SA, et al. Patients' experiences of enhanced recovery after surgery: a systematic review of qualitative studies. J Clin Nurs, 2017, 26(9-10): 1172-1188.
27.	Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg, 2017, 152(3): 292-298.
28.	英衛東. 加速康復外科多學科團隊建設. 中華外科雜志, 2018, 56(1): 14-17.

1. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
2. Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr, 2005, 24(3): 466-477.
3. Basse L, Hjort Jakobsen D, Billesb?lle P, et al. A clinical pathway to accelerate recovery after colonic resection. Ann Surg, 2000, 232(1): 51-57.
4. Melnyk M, Casey RG, Black P, et al. Enhanced recovery after surgery (ERAS) protocols: time to change practice? Can Urol Assoc J, 2011, 5(5): 342-348.
5. 黎介壽. 對Fast-track Surgery (快通道外科)內涵的認識. 中華醫學雜志, 2007, 87(8): 515-517.
6. 江志偉, 黎介壽, 汪志明, 等. 胃癌患者應用加速康復外科治療的安全性及有效性研究. 中華外科雜志, 2007, 45(19): 1314-1317.
7. 江志偉, 黎介壽, 汪志明, 等. 加速康復外科用于直腸癌前切除病人價值探討. 中國實用外科雜志, 2008, 28(1): 59-61.
8. 黎介壽, 江志偉. 加速康復外科的臨床意義不僅僅是縮短住院日. 中華消化外科雜志, 2015, 14(1): 22-24.
9. Varadhan KK, Neal KR, Dejong CH, et al. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr, 2010, 29(4): 434-440.
10. 童衛東. 結直腸外科圍手術期處理的革命性進展—加速康復外科理念. 國際外科學雜志, 2011, 38(8): 508-510.
11. 陳孝平. “兩減一保” —中國醫生早年對病人加速康復的認識與實踐. 腹部外科, 2017, 30(2): 73-74.
12. 陳凜, 陳亞進, 董海龍, 等. 加速康復外科中國專家共識及路徑管理指南(2018版). 中國實用外科雜志, 2018, 38(1): 1-20.
13. Abeles A, Kwasnicki RM, Darzi A. Enhanced recovery after surgery: Current research insights and future direction. World J Gastrointest Surg, 2017, 9(2): 37-45.
14. 雷澤華, 謝青云, 趙欣, 等. “LEER”模式加速康復外科理念在胰十二指腸切除術中的應用. 肝膽胰外科雜志, 2020, 32(3): 138-142.
15. van Dam RM, Hendry PO, Coolsen MM, et al. Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection. Br J Surg, 2008, 95(8): 969-975.
16. Koea JB, Young Y, Gunn K. Fast track liver resection: the effect of a comprehensive care package and analgesia with single dose intrathecal morphine with gabapentin or continuous epidural analgesia. HPB Surg, 2009, 2009: 271986.
17. Savikko J, Ilmakunnas M, M?kisalo H, et al. Enhanced recovery protocol after liver resection. Br J Surg, 2015, 102(12): 1526-1532.
18. Qi S, Chen G, Cao P, et al. Safety and efficacy of enhanced recovery after surgery (ERAS) programs in patients undergoing hepatectomy: a prospective randomized controlled trial. J Clin Lab Anal, 2018, 32(6): e22434.
19. Zhao Y, Qin H, Wu Y, et al. Enhanced recovery after surgery program reduces length of hospital stay and complications in liver resection: a PRISMA-compliant systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore), 2017, 96(31): e7628.
20. 韓冰, 丁義濤, 朱新華, 等. 加速康復外科理念在腹腔鏡肝切除術中的應用. 臨床肝膽病雜志, 2018, (3): 567-572.
21. 駱鵬飛, 莢衛東, 許戈良, 等. 加速康復外科理念在原發性肝癌患者肝切除圍手術期中的應用. 中華普通外科雜志, 2015, 30(11): 862-865.
22. Sánchez-Pérez B, Aranda-Narváez JM, Suárez-Mu?oz MA, et al. Fast-track program in laparoscopic liver surgery: Theory or fact? World J Gastrointest Surg, 2012, 4(11): 246-250.
23. 朱斌, 黃建宏. 加速康復外科在我國發展現狀、挑戰與對策. 中國實用外科雜志, 2017, 37(1): 26-27.
24. Visioni A, Shah R, Gabriel E, et al. Enhanced recovery after surgery for noncolorectal surgery?: a systematic review and meta-analysis of major abdominal surgery. Ann Surg, 2018, 267(1): 57-65.
25. 姜洪池, 李丹. 實施加速康復外科若干問題思考. 中國實用外科雜志, 2017, 37(1): 1-4.
26. Sibbern T, Bull Sellevold V, Steindal SA, et al. Patients' experiences of enhanced recovery after surgery: a systematic review of qualitative studies. J Clin Nurs, 2017, 26(9-10): 1172-1188.
27. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg, 2017, 152(3): 292-298.
28. 英衛東. 加速康復外科多學科團隊建設. 中華外科雜志, 2018, 56(1): 14-17.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of “LEER” mode accelerated rehabilitation surgery concept in laparoscopic anatomical hepatectomy

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