Abstract Hepatobiliary and pancreatic surgery encompasses a field of highly complex procedures, causing relevant perioperative morbidity and mortality, even in specialized centers. Protocols for enhanced recovery after surgery (ERAS) aim to optimize the pre-, peri-, and postoperative courses to improve recovery quality and costs. In this short and comprehensive review, we discuss the current literature on ERAS protocols in hepatobiliary and pancreatic surgery, focusing mainly on articles published between 2024 and 2026. ERAS principles facilitate less postoperative complications and shorter hospital stays after hepatobiliary and pancreatic surgery, thus reducing costs related to longer hospitalization. In hepatic surgery, minimally invasive surgery is a key component of recent ERAS protocols, while in pancreatic surgery, there is still no recommendation for minimally invasive surgery in the ERAS protocol from 2019. Patients with liver cirrhosis represent an extremely vulnerable group when undergoing surgery and special items were presented to optimize ERAS protocols. In pancreatic surgery, advanced age and lack of fitness due to sarcopenia, cachexia, and malnutrition challenge postoperative recovery. However, despite reduction of complication rates and time of hospital stay, the implementation of ERAS programs in hepatobiliary and pancreatic surgery remains challenging, and the used protocols are highly heterogeneous. Further research will be needed to support the relevance of ERAS programs and develop new specific recommendations for high risk groups.
Abstract Objectives To estimate and compare the socioeconomic burden of craniomaxillofacial (CMF) trauma surgery in Japan and Germany across the prepandemic, pandemic, and postpandemic periods, considering each country’s health insurance system. Methods We performed a secondary analysis integrating two national database studies. Japanese data (NDB; K-code and J-code billing, 2016–2023, 49,379 procedures) were combined with German data (InEK; 2019–2023, approximately 440,000 diagnoses). Costs were calculated using Japan’s fee-for-service schedule and the German DRG (G-DRG) system. Importantly, the Japanese dataset enumerates surgical procedures, whereas the German dataset enumerates inpatient diagnoses; this fundamental difference in unit of measurement must be considered when interpreting all comparative results below. Results In Japan, annual direct surgical cost averaged ¥1,061.7 million ($7.08M USD) prepandemic, declining 19.19 % to ¥858.0 million during the pandemic, with a small persistent postpandemic gap (−1.69 %). In Germany, annual inpatient CMF costs totaled €181.2 million prepandemic, declining by 19.24 % to €146.3 million. Patient copayments differed markedly: Japanese patients bore 30 % of costs (¥48,608/case), vs. approximately €40/case in Germany. Conclusions Despite different financing models, both countries showed strikingly similar pandemic-related cost reductions (Japan −19.19 %, Germany −19.24 %). Japan’s fee-for-service model creates greater revenue sensitivity to volume changes, whereas the G-DRG system provides partial buffering. The pronounced per-case copayment disparity (approximately 7.5-fold higher in Japan in USD terms) raises questions about healthcare equity, though any effect on care-seeking behavior remains speculative. As the Japanese and German data sources reflect surgical procedures and clinical diagnoses, respectively, these findings are not directly volume-equivalent and should be interpreted accordingly.
Abstract Objectives Neoadjuvant chemotherapy (NACT) is commonly incorporated into the management of resectable locally advanced gastric cancer. However, survival outcomes in patients who remain classified as pathological stage IIIC after surgery, particularly when analyzed according to NACT exposure, are not well characterized. This study compares overall survival (OS) according to prior NACT exposure among patients who ultimately remained classified as pathological stage IIIC after curative surgery. Methods This retrospective study included patients who underwent curative surgery between 2010 and 2022 and were diagnosed with pathological stage IIIC gastric cancer on postoperative histopathological examination. Patients were grouped according to whether they received NACT. OS was measured from surgery to death from any cause or last follow-up. Survival was analyzed using the Kaplan–Meier method and Cox proportional hazards regression. Results The study cohort comprised 75 patients, of whom 24.0 % (18/75) received NACT. OS did not differ significantly between patients who received NACT and those who did not, as assessed by the log-rank test (p=0.749). In multivariable Cox regression analysis, NACT was not identified as an independent factor associated with OS (HR: 0.96; 95 % CI: 0.50–1.84; p=0.902). Conclusions Within the limitations of this retrospective study, overall survival was comparable according to neoadjuvant chemotherapy status among patients who ultimately remained classified as pathological stage IIIC after curative surgery. These findings should be interpreted cautiously because the compared groups represent biologically distinct populations and the study was not designed to evaluate the therapeutic efficacy of neoadjuvant chemotherapy.
Abstract Objectives The aim of this prospective data analysis was to evaluate the patient reported quality of postoperative recovery in patients undergoing elective minimally invasive colorectal surgery and to assess the impact of a ERP (Enhanced Recovery After Surgery Protocol) compared to traditional perioperative care. Methods 158 patients undergoing elective colorectal surgery were prospectively enrolled. The first 28 patients were treated during 3 months of ERP development and received standardized traditional care. The following 130 patients were treated under optimized perioperative management with an ERP. Quality of recovery was assessed using the validated QoR-15 questionnaire on postoperative days 2 and 5. Secondary outcomes included the pre- and postoperative length of hospital stay. The functional recovery, compliance to ERP and postoperative mobilization times were also measured. Results Patients in the ERP group showed significantly higher QoR-15 scores on both postoperative day 2 and day 5 compared to the traditional care group indicating a better quality of patient perceived recovery. The duration of initial intensive care observation, the time until removal of the urinary catheter, first bowel movement and until regaining autonomy were all significantly reduced in patients treated according to the ERP. Similarly, mobilization times on the day of surgery as well as on postoperative days 1–3 were significantly longer in the ERP group, indicating earlier and more consistent patient activity. These findings reflect a faster restoration of physiological function and independence The ERP group also had a shorter median length of stay (6 vs. 8 days) correlating with a faster functional recovery. Conclusions Implementation of an ERP in elective colorectal surgery significantly improves patient-reported quality of recovery, accelerates functional recovery and reduces length of hospital stay. Key determinants of early postoperative recovery were the baseline recovery status and the occurrence of postoperative complications, whereas demographic or procedural variables appeared to have less impact.
Objectives: Numerous studies have demonstrated that compliance to surveillance protocols after endovascular aneurysm repair (EVAR) diminishes over time. Additionally, the survival benefit of strict adherence to surveillance is unclear. This study aimed to evaluate compliance and long-term mortality following EVAR. Methods: We conducted a retrospective analysis of all EVAR patients (n=310) with expected follow-up treated between 01/2008 and 12/2020. Demographic data and potential risk factors for non-compliance were analyzed. Compliance was defined as verified follow-up at a maximum interval of 15 months. Results: Overall, 118 patients (38.1 %) died during follow-up. At a median follow-up of 14 [IQR 2, 41] months, 40.3 % of patients were compliant to the follow-up regimen. The presence of endoleak did not significantly influence compliance (p=0.246), but compliance was linked to a higher risk of detected endoleak and reinterventions (p<0.01; p<0.001). Age, sex, marital status, assessed comorbidities, AAA diameter, rupture, urgency of the operation and travel distance to the hospital were not associated with compliance to follow-up. A multivariable time-dependent Cox model with compliance as a time-varying covariate showed non-compliance was linked to a lower hazard of death (p<0.001) with a significant time interaction (beta=0.03, p<0.001), indicating a time-varying effect. The Kaplan-Meier analysis found no difference in survival between groups (p=0.105). Conclusions: Our study showed no survival benefit for patients compliant to follow-up after EVAR. Competing risks analyses revealed higher rates of endoleaks and reinterventions among compliant patients reflecting more intensive surveillance and detection.
