Enhanced Recovery After Liver Surgery: Does Compliance Impact Survival?

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.

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Journal
Annals of Surgical Oncology
Published
2026-04-02
DOI
https://doi.org/10.1245/s10434-026-19459-7
Citations
1
Primary Topic
Enhanced Recovery After Surgery
Type
article
Field-Weighted Citation Impact
24.54

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article

Enhanced Recovery After Liver Surgery: Does Compliance Impact Survival?

Théophile Guilbaud, Raffaele Brustia, Paul Vigneron, K. Slim et al.
1 citations
Annals of Surgical Oncology
Enhanced Recovery After Surgery
24.54
article

Enhanced Recovery After Liver Surgery: Does Compliance Impact Survival?

Théophile Guilbaud, Raffaele Brustia, Paul Vigneron, K. Slim, Martina Mariatti, Fabrice Muscari, Alexandre Doussot, Olivier Detry, Alessandra Cristaudi, Aurélien Dupré, Olivier Facy, Giuliana Amaddeo, Francesca Venza, Paul Boulard, Gabriel Thierry, Isabella Hunjan, Danièle Sommacale, Rabih-Tany Mikhael, David-Jérémie Birnbaum, Pascale Mariani, Nicolas Mouton, Benjamin Muller, Lorenzo Bernardi, Guillaume Passot, Eddy Cotte
article en
1 citations

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.

Annals of Surgical Oncology
Université Claude Bernard Lyon 1 (FR), Inserm (FR), University of Liège (BE), Université Fédérale de Toulouse Midi-Pyrénées (FR), Université Paris-Est Créteil (FR), Aix-Marseille Université (FR), Université Paris Sciences et Lettres (FR), Centre Hospitalier Universitaire de Toulouse (FR), Assistance Publique Hôpitaux de Marseille (FR), Centre Hospitalier Universitaire de Besançon (FR), Ente Ospedaliero Cantonale (CH), Assistance Publique – Hôpitaux de Paris (FR), Centre Léon Bérard (FR), Immunité et Cancer (FR), Hôpital Lyon Sud (FR), Hôpital Nord (FR), CHU Dijon Bourgogne (FR), Fédération Francophone de Cancérologie Digestive (FR), Centre Hospitalier Universitaire de Clermont-Ferrand (FR), Hôpitaux Universitaires Henri-Mondor (FR), Groupe Francophone des Myélodysplasies (FR), Institut Curie (FR)
Université Paris-Est Créteil Val-de-Marne
Openalex Percentile: Top 1%
Enhanced Recovery After Surgery
24.54
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