Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Enhanced recovery programs (ERPs) improve short-term outcomes after liver surgery (LS), but their impact on survival remains uncertain. This study evaluated the association between ERP compliance and survival in a large multicenter cohort. METHODS: This prospective European multicenter cohort included adults undergoing elective LS between 2016 and 2024 in 10 centers implementing Enhanced Recovery After Surgery (ERAS)-consistent ERPs. Compliance was defined as the proportion of 21 fulfilled items with high compliance (≥70%). A 1:1 propensity score-matching was performed to balance baseline characteristics. The primary outcome was 12 month overall survival (OS). Secondary outcomes included predictors of 12 month and long-term OS and cancer-specific subgroup analyses. Cox regression models, Kaplan-Meier analyses, and sensitivity analyses including center effects were used. RESULTS: Among 1860 patients, 453 (24.4%) achieved high ERP compliance. After matching, 437 well-balanced pairs (n = 874) were analyzed. The 12-month OS did not differ significantly between the high- and low-compliance groups before (95% vs. 92%; p = 0.081) or after (96% vs. 92%; p = 0.11) matching. In the matched cohort, high ERP compliance was not independently associated with 12 month mortality (adjusted hazard ratio, 0.68; 95% confidence interval, 0.36-1.30; p = 0.20). Long-term mortality was independently associated with metastatic disease, operative duration longer than180 min, and intraoperative hypotension. In subgroup analyses after matching, improved survival with high compliance was observed only for patients with colorectal liver metastases (p = 0.029). CONCLUSION: High ERP compliance reduces perioperative morbidity but is not independently associated with 12 month or long-term survival after LS.
Source: Annals of Surgical Oncology
Authors: Martina Mariatti, Francesca Venza, Alessandra Cristaudi, Lorenzo Bernardi, Isabella Hunjan, Paul Boulard, Fabrice Muscari, Eddy Cotte, Guillaume Passot, Pascale Mariani, Rabih-Tany Mikhael, Olivier Detry, Gabriel Thierry, Benjamin Muller, Olivier Facy, Aurélien Dupre, Nicolas Mouton, David-Jérémie Birnbaum, Théophile Guilbaud, Giuliana Amaddeo, Paul Vigneron, Daniele Sommacale, Karem Slim, Alexandre Doussot, Raffaele Brustia
Institutions: Inserm, Université Paris-Est Créteil, Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Centre Hospitalier Universitaire de Besançon, Ente Ospedaliero Cantonale, Università della Svizzera italiana, Centre Hospitalier Universitaire de Toulouse, Hôpital Lyon Sud, Université Paris Sciences et Lettres, Institut Curie, University of Liège, Centre Hospitalier Universitaire de Liège, CHU Dijon Bourgogne, Centre Léon Bérard, Laboratoire des applications Thérapeutiques des Ultrasons, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Centre Hospitalier Universitaire Henri-Mondor
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,590
OpenAlex ID: W7148606361