A new study highlights the effectiveness of an enhanced recovery program that allows patients of oncologic liver operations to return to their normal life and additional cancer therapies earlier as compared to conventional perioperative approaches. Researchers claim that the findings propose hope for developing a better scientific definition of ‘recovery’ for other diseases as well – comparing and contrasting different enhanced recovery strategies can ultimately lead to an effective and efficient approach.
The Study On Liver Surgery: Assessing The Effects Of Enhanced Recovery On Patients
The key to a successful recovery regime is how effectively it can restore normal life functioning. Currently, physicians focus on symptoms such as nausea, pain and fatigue, but the actual assessment should aim to look at how these symptoms influence each patient’s daily functions.
“We found that even extremely symptomatic people could be reasonably functional and mildly symptomatic people could be completely disabled”, explained lead investigator Thomas A. Aloia, MD, FACS, Associate Professor, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston.
The study included 118 patients from a single centre undergoing open and laparoscopic hepatectomy (surgical resection of the liver). Apart from conventional quality metrics such as complications and duration of stay, the researchers collected data using a patient-reported outcomes tool – MD Anderson Symptom Inventory (MDASI). The patients rated the severity of their symptoms and life interference preoperatively and then again after every outpatient visit for a period of 31 days after their operations.
The patients were divided into two groups: 75 patients in the enhanced recovery group and 43 patients in the traditional care group. Besides the enhanced recovery part, similar preoperative and postoperative care was given to both groups. The idea then was to compare the difference between functional outcomes.
The Results: Enhanced Recovery Has It’s Benefits
Traditionally, surgeons counsel patients regarding how they would feel after a month of the operations, highlighting the fact that a full recovery would take at least six to eight weeks. The concept of ‘enhanced recovery’ is to administer a multi-component perioperative care protocol aimed to accelerate the patients’ recovery for resuming normal life functions.
To elaborate, the multi-component perioperative care involves perioperative education, use of less narcotic painkillers and a speedy return to eating and walking. It was seen that the patients treated with this regime were 2.6 times more likely to attain their baseline functional status within a month after their operation as compared to the traditional group.
“The size of the liver resection, the approach [laparoscopic or open operation], or whether an epidural catheter for pain control was used did not account for the observed differences”, said Dr. Aloia. “The only independent factor that correlated to a quicker return to baseline functional status, both in terms of absolute value and short time to recovery, was the administration of enhanced recovery protocol”.
Liver surgery: Moreover, the enhanced recovery patients rated their postoperative pain to be lower, along with fewer post-operative complications and reduced duration of stay.
Return To Additional Cancer Therapies
Another significant aspect was that enhanced recovery patients were likely to resume chemotherapy (a measure created by researchers at the center called Return to Intended Oncologic Therapy: RIOT) quicker as compared to those given the traditional protocol. These recently may not be statistically significant, but they do indicate a clear trend of the efficacy of the enhanced treatment approach. The study was published online on the Journal of the American College of Surgeon’s website.