What question did this study set out to answer?

To evaluate the effect of ERAS adherence on postoperative complications and long-term survival in patients undergoing surgery for perihilar cholangiocarcinoma.

June 12, 2026Open Access

Impact of enhanced recovery after surgery (ERAS) on postoperative morbidity and long-term survival in patients with perihilar cholangiocarcinoma

RORobert OehringHumboldt-Universität zu Berlin EKEriselda KeshiHumboldt-Universität zu Berlin MBMarlen BreitkreuzHumboldt-Universität zu Berlin

Key Points

To evaluate the effect of ERAS adherence on postoperative complications and long-term survival in patients undergoing surgery for perihilar cholangiocarcinoma.
Included 168 patients undergoing extended liver surgery with reconstruction from 2014 to 2024.
Compared 94 patients treated with ERAS guidelines to 74 control patients not treated with ERAS.
Analyzed postoperative complications, adherence rates, and survival outcomes.
ERAS reduced overall complication rates from 97.3% (non-ERAS) to 83.0% (ERAS) with p = 0.003.
Within ERAS, higher adherence (≥ 50%) led to complication rates of 78.2% vs 100% (p = 0.031) in lower adherence (< 50%).
Survival was improved in ERAS-managed patients compared to non-ERAS with p = 0.037, but this was not significant after adjusting for other factors.

Abstract

Abstract Purpose Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care pathway designed to improve surgical outcomes and has been widely adopted across surgical disciplines. This study evaluated the impact of adherence to ERAS Society recommendations on postoperative complications and survival in patients undergoing surgery for perihilar cholangiocarcinoma (PCH). Methods A total of 168 patients with PCH who underwent extended liver surgery with hepatobiliary reconstruction between 2014 and 2024 were included. Of these, 94 patients were treated according to the official ERAS protocol, while 74 patients treated prior to ERAS program implementation served as the control group (Non-ERAS). The ERAS program followed strictly the official ERAS Society guidelines. Patients were analyzed with regard to postoperative complications, adherence to ERAS measures, and long-term survival. Results ERAS was associated with a significant reduction in overall complications (Clavien-Dindo grades 1–5), Non ERAS 97.3% vs. ERAS 83.0% ( p = 0.003). Within the ERAS group, lower complication rates were observed in patients with higher adherence (≥ 50%) compared to those with lower adherence (< 50%), 78.2% vs. 100% ( p = 0.031). Overall adherence in the ERAS group was 64.3%, with the highest adherence seen for preoperative items (80.7%). When ERAS was coordinated by dedicated ERAS staff, overall survival was significantly improved compared to the non-ERAS group ( p = 0.037). However, this association was no longer observed after multivariable adjustment. Instead, the administration of adjuvant chemotherapy and younger age emerged as independent predictors of prolonged survival. Conclusions Implementation of the ERAS program in patients undergoing extended liver resection for PCH is feasible and safe. It was associated with a reduction in postoperative complications and a trend towards improved overall survival. These effects were most pronounced when the ERAS protocol was guided and supervised by dedicated ERAS staff.

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