Minimizing surgical burden for HPB patients throughout the perioperative pathway

In this doctoral thesis investigated how perioperative care in liver and pancreatic surgery can be improved by reducing the physical burden on patients.
The first part focuses on specific ERAS elements. One study showed that routine abdominal drains after liver surgery are not necessary and can be safely omitted. A randomized trial demonstrated that use of laxatives preoperatively did not improve postoperative recovery after liver surgery.
Two studies examined preoperative work-up strategies. One showed that the “liver-first” approach for patients with colorectal liver metastases is a safe and effective treatment option. Another revealed substantial variation in clinical practice regarding preoperative bile duct drainage before pancreaticoduodenectomy in the Netherlands.
The final part highlights the importance of patient-related factors such as frailty and nutritional status. A nationwide study showed that carefully selected elderly patients can achieve acceptable long-term outcomes after liver surgery, indicating that age alone should not be a reason to withhold surgery.