Impact of ERAS compliance on the delay between surgery and adjuvant chemotherapy in hepatobiliary and pancreatic maligna
- PDF / 480,599 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 71 Downloads / 168 Views
ORIGINAL ARTICLE
Impact of ERAS compliance on the delay between surgery and adjuvant chemotherapy in hepatobiliary and pancreatic malignancies Pénélope St-Amour 1 & Pascal St-Amour 2 & Gaëtan-Romain Joliat 1 & Aude Eckert 3 & Ismail Labgaa 1 & Didier Roulin 1 & Nicolas Demartines 1 & Emmanuel Melloul 1 Received: 23 April 2020 / Accepted: 1 September 2020 # The Author(s) 2020
Abstract Background Multidisciplinary approach with adjuvant chemotherapy is the key element to provide optimal outcomes in pancreas and liver malignancies. However, post-operative complications may increase the interval between surgery and chemotherapy with negative oncologic effects. Hypothesis and study aim The aim of the study was to analyse whether compliance to Enhanced Recovery After Surgery (ERAS) pathway was associated with decreased interval to adjuvant chemotherapy. Methods Retrospective analysis of all consecutive ERAS patients with surgery for hepatobiliary or pancreatic malignancies at the University Hospital of Lausanne between 2012 and 2016. Multivariate analysis was performed to assess the impact of ERAS compliance on time to chemotherapy. Results A total of 133 patients with adjuvant chemotherapy were included (n = 44 liver and n = 89 pancreatic cancer). Median compliance to ERAS was 61% (IQR 55–67) for the study population, and median delay to chemotherapy was 49 days (IQR 3961). Overall, compliance ≥ 67% to ERAS induced a significant reduction in the interval between surgery and chemotherapy for young patients (< 65 years old) with or without severe comorbidities (reduction of 22 and 10 days, respectively). High compliance in young ASA3 patients with liver colorectal metastases was associated with an increase of 481 days of DFS. Conclusions ERAS compliance ≥ 67% tends to be associated with a reduction in the delay to adjuvant chemotherapy for young patients with hepatobiliary and pancreatic malignancies. More prospective studies with strict adhesion to the ERAS protocol are needed to confirm these results. Keywords ERAS . Liver surgery . Pancreatic surgery . Adjuvant chemotherapy
Abbreviation ASA American Society of Anesthesiology CCI Comprehensive Complication Index
DFS EIAS ERAS MDT OS
* Nicolas Demartines [email protected]
Introduction
1
Department of Visceral Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
2
Department of Economics, HEC Lausanne, University of Lausanne (UNIL), Lausanne, Switzerland
3
Department of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
Disease-free survival ERAS Interactive Audit System Enhanced Recovery After Surgery Multidisciplinary tumour board Overall survival
Pancreas and liver malignancies are common tumours with increasing incidence and poor prognosis. Five-year survival is 9% for all stages of pancreas malignancies and 18% for liver malignancies [1]. To improve this unfavourable outcome, multidisciplinary approach including neo- or adjuvant chemotherapy combined with surgical resection has become the be
Data Loading...
