Implementation of enhanced recovery after surgery (ERAS) in laparoscopic left lateral hepatectomy on hepatocellular carcinoma patients: necessary or not?

In this study, we aim to determine the application of enhanced recovery after surgery (ERAS) in single incision and multiple ports laparoscopic hepatectomy. Ninety-five patients undergoing laparoscopic left lateral hepatectomy for hepatocellular carcinoma (HCC) were included and divided into three groups: pre-MPH group (n=35), received pre-ERAS multiple ports procedures; SPE group (n=27), received single port ERAS procedures; MPE group (n=33) received multiple ports ERAS procedures. Outcomes were compared in terms of operative related outcomes, liver functional recovery, postoperative complications, hospital stay, hospitalization expense and readmissions. There were no significant differences in the prevalence of complication (P=0.601), hospital stay (P=0.645) and total cost (P=0.297) between pre-MPH group and MPE group. No readmission was noticed within 30 days after surgery in each group. No significant differences were observed in blood loss (P=0.086), resection margin (P=1.000) and mobility rate (P=0.425) between SPE group and MPE group. The operation time was shorter in the patients received single port surgery compared to these received multiple ports surgery (P=0.032). The levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were increased on day 1 after surgery, and decreased to normal level on day 5 in the three groups. ERAS programs might be not necessary for patients underwent laparoscopic left lateral hepatectomy. The perioperative outcomes are similar between multiple ports and single port laparoscopic left lateral hepatectomy.