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BACKGROUND: Laparoscopic procedures have gained popularity because they favor a faster recovery. In the same way, the establishment of an enhanced recovery after surgery (ERAS) program in major abdominal surgery has shortened the hospital stay. There are several studies that report the results on ERAS programs applied to open or laparoscopic hepatectomies or comparing one of them with the classic approach but few have compared the results between both within an ERAS program. OBJECTIVE: To compare the results between open and laparoscopic hepatectomies in the same ERAS program. METHOD: Thirty-six patients undergoing hepatectomies were enrolled in this study and were either laparoscopically or open in an identical ERAS program. Hospital stay and the number of complications were taken as primary end points. RESULTS: There were no significant differences between both groups in terms of hospital stay or number of complications. The differences were in a shorter time of surgery and an earlier ambulation in favor of open surgery and a better full recovery in favor of the laparoscopic approach. CONCLUSIONS: Initial data suggest that there would be no benefits in terms of hospital stay and complication rate of laparoscopic hepatectomies over open ones within an ERAS program.

ANTECEDENTES: Los procedimientos laparoscópicos ganaron popularidad porque favorecen una recuperación rápida. El establecimiento de programas ERAS (Enhanced Recovery After Surgery) en cirugía mayor abdominal ha acortado la estancia hospitalaria independientemente de la vía de abordaje. Varios trabajos informan los resultados sobre programas ERAS aplicados a hepatectomías abiertas o laparoscópicas, o comparando una de ellas con el abordaje clásico, pero pocos han comparado los resultados entre ambas dentro de un programa ERAS. OBJETIVO: Comparar, dentro un mismo programa ERAS, los resultados entre hepatectomías abiertas y laparoscópicas. MÉTODO: Se incorporaron a este estudio 36 pacientes sometidos a hepatectomías que fueron abordados por vía laparoscópica o abierta dentro de un programa ERAS. Los objetivos primarios fueron la estancia hospitalaria y el número de complicaciones. RESULTADOS: No hubo diferencias significativas entre ambos grupos en cuanto a estancia hospitalaria ni número de complicaciones. Las diferencias radicaron en un menor tiempo de cirugía y una deambulación más precoz a favor de la cirugía abierta, y una recuperación total mejor a favor del abordaje laparoscópico. CONCLUSIONES: Los datos iniciales sugieren que no habría beneficios en cuanto a estancia hospitalaria e índice de complicaciones de las hepatectomías laparoscópicas sobre las abiertas dentro de un programa ERAS.

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INTRODUCTION: Surgical treatment of hilar cholangiocarcinoma remains a challenge. Multiple prognostic factors have been proposed. The number of positive nodes and the ratio between positive lymph node and total lymph node (G+/Gt) are considered by some authors as the most important factor. MATERIAL AND METHODS: We analyzed a series of 58 patients with Klatskin tumors. We evaluated the prognostic factors and survival with emphasis on the prognostic impact of the number of positive nodes and its relation to total lymph nodes. RESULTS: Resectability was 78% with a 5-year survival of 32%. The median number of nodes examined was 9.5. No significant differences were found in several of the proposed prognostic factors. The presence of 2 or more positive nodes or a ratio G+/Gt ≥ 0.2 were found to be poor prognostic factors. CONCLUSION: The relationship between positive lymph nodes and total lymph nodes and the number of positive lymph nodes are important prognostic factors.

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