Background

Gallbladder cancer (GBC) is the sixth most common gastrointestinal malignancy with poor prognosis. Enhanced Recovery Pathway (ERP) is associated with improved outcomes following abdominal surgical procedures. Currently, there is no study evaluating ERP in patients undergoing GBC surgery. The objective was to assess compliance with ERP elements and evaluate its impact on postoperative outcomes.

Methods

Prospective study conducted from February 2014–2019, including elective GBC surgery. Team was educated prior to ERP implementation. Compliance with the protocol, functional gastrointestinal (GI) recovery, mobilisation, and postoperative outcomes were recorded. Impact of degree of compliance (more or less than 80%) with ERP and postoperative outcomes was evaluated.

Results

In 408 patients, compliance with ERP was 84.6% (53.8–100%). Compliance >80% with ERP elements was observed in 245 patients (60%). Patients with >80% compliance had lower rate of minor (18.8% vs. 27%, p = 0.050) and significantly less major (0.8% vs. 6.1%, p = 0.002) and postoperative stay (5.84 ± 4.86 vs. 7.55 ± 6.6 days, p < 0.001) and earlier functional GI recovery. Intraoperative blood loss more than 600 ml, lower compliance (<80%) with ERP and preoperative albumin independently predicted postoperative complications.

Conclusion

This study demonstrates safety and efficacy of enhanced recovery pathway in gallbladder cancer. Higher compliance with the pathway was associated with significantly improved postoperative outcomes following gallbladder cancer surgery.

中文翻译：

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增强恢复通路对 408 例胆囊癌切除术的影响

背景

胆囊癌（GBC）是第六大常见的胃肠道恶性肿瘤，预后不良。增强恢复途径 (ERP) 与腹部外科手术后改善的结果相关。目前，没有研究评估接受 GBC 手术的患者的 ERP。目的是评估对 ERP 要素的依从性并评估其对术后结果的影响。

方法

2014 年 2 月至 2019 年进行的前瞻性研究，包括选择性 GBC 手术。团队在 ERP 实施之前接受了教育。记录对方案的遵守情况、功能性胃肠道 (GI) 恢复、活动和术后结果。评估了对 ERP 和术后结果的依从度（大于或小于 80%）的影响。

结果

在 408 名患者中，对 ERP 的依从性为 84.6% (53.8–100%)。在 245 名患者 (60%) 中观察到对 ERP 元素的依从性 >80%。依从性 > 80% 的患者轻微（18.8% vs. 27%，p = 0.050）和主要（0.8% vs. 6.1%，p = 0.002）和术后住院率（5.84 ± 4.86 vs. 7.55 ± 6.6 天，p < 0.001）和更早的功能性胃肠道恢复。术中失血超过 600 毫升、对 ERP 和术前白蛋白的依从性较低（<80%）可独立预测术后并发症。

结论

这项研究证明了胆囊癌增强恢复途径的安全性和有效性。对该途径的更高依从性与胆囊癌手术后显着改善的术后结果相关。