Abstract :
[en] Introduction: Significant advancements in the manage-
ment of patients undergoing liver surgery (LS) have been
achieved; however, postoperative morbidity remains a key
determinant of long-term survival. The enhanced recovery
program (ERP), a multimodal, evidence-based care pro-
tocol, aims to mitigate the physiological stress induced by
surgery, with robust evidence supporting a dose-response
relationship between compliance and improved clinical
outcomes. This study investigates the association between
high compliance with ERP protocols and overall survival
(OS) following LS.
Method: This prospective multicenter cohort study
compared OS among patients with high ERP compliance
(≥70%, defined as adherence to at least 15 of 21 protocol
items) to those with low compliance (<70%). Data were
collected from french and belgian tertiary centers between
2019 and 2024 participating to the PRESTIGE Cohort (erP
incReasE Survival afTer lIver surGEry).
Results: Of 360 patients included, 153 (42.6%) exhibited
high ERP compliance. Kaplan-Meier OS estimates at 1, 3,
and 5 years were 97%, 91%, and 70% in the high
compliance group, compared to 89%, 67%, and 45% in the
low compliance group (p < 0.001). High ERP compliance
was independently associated with reduced mortality risk
(HR: 0.05, 95% CI: 0.27—0.93, p = 0.028). Conversely,
severe weight loss (HR: 7.8, 95% CI: 1.55—39.8, p =
0.013) and higher ASA scores (ASA-2: HR: 7.8, 95% CI:
1.1—58.2, p = 0.045; ASA-3: HR: 11.4, 95% CI: 1.5—85.9,
p = 0.018) were significantly associated with increased
mortality.
Conclusion: High compliance with ERP protocols
significantly enhances long-term survival following liver
surgery, underscoring the importance of implementing
structured perioperative care strategies. Conversely, severe weight loss and elevated ASA scores serve as critical
predictors of poorer outcomes.
