Safety and efficacy of the enhanced recovery after surgery protocol in hepatectomy for liver cancer

Purpose: The aim of this research was to evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) protocol in hepatectomy patients with liver cancer. Materials and methods: We searched three databases, including PubMed, Embase, and the Cochrane Library database, from inception to April 25, 2023. The outcomes were postoperative complications, and postoperative length of stay (PLOS). This study was performed by Stata (V. 16.0) software. Results: Twelve investigations involving 1,892 patients were included in this study. The ERAS group had lower overall postoperative complications [odds ratio (OR) = 0.49, I2 = 54.89 %, 95 % confidence interval (CI) = 0.33-0.74, P = 0.00], postoperative Clavien-Dindo Grade 1-2 complications (OR = 0.39, I2 = 55.14 %, 95 %CI = 0.23-0.69, P = 0.00), Clavien-Dindo Grade 3-4 complications (OR = 0.56, I2 = 0.00 %, 95 %CI = 0.38-0.83, P = 0.00) , pneumonia (OR = 0.34, I2 = 0.00 %, 95 %CI = 0.15-0.76, P = 0.01), ascites (OR = 0.25, I2 = 0.00 %, 95 %CI = 0.09-0.68, P = 0.01), vomit (OR = 0.39, I2 = 0.00 %, 95 %CI = 0.21-0.73, P = 0.00), intraoperative blood loss [mean difference (MD) = 1.69, I2 = 0.00 %, 95 %CI = 1.15-2.47, P = 0.01], PLOS (MD = -0.42, I2 = 94.87 %, 95 %CI = -0.86-0.03, P = 0.07), duration of abdominal drain (MD = -1.23, I2 = 96.96 %, 95 %CI = -2.04 to -0.42, P = 0.00), and hospital readmission (OR = 0.44, I2 = 0.00 %, 95 %CI = 0.23-0.85, P = 0.01) compared to the non-ERAS group. Conclusion: For patients with liver cancer treated with ERAS. The ERAS protocol reduces the percentage of overall postoperative complications. Moreover, ERAS does not increase the rate of blood transfusions, hospital readmission, reoperation, or mortality.