# Enhanced recovery after liver surgery (ERAS pathway for hepatectomy)

Source: https://onco.cc/protocols/enhanced-recovery-after-liver-surgery/  
OnCo record `enhanced-recovery-after-liver-surgery` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Enhanced recovery is a package of care that helps people recover faster from liver surgery: preparation and stopping smoking and heavy drinking beforehand, a short fast with a sugary drink, keyhole surgery where possible, good pain relief that keeps you mobile, no routine tubes or drains, eating and getting out of bed on the day of surgery, and blood clot prevention.

## Summary

The ERAS Society liver surgery recommendations (2022; 25 items, all with more than 80% agreement after three Delphi rounds) grade each element by GRADE. Strong recommendations with high-quality evidence: smoking cessation at least 4 weeks and alcohol cessation 4 to 8 weeks before surgery for heavy drinkers; nutritional assessment for all, with 7 to 14 days of enteral supplementation for the malnourished; continuous wound infiltration or TAP block as part of analgesia; no routine nasogastric tube; no routine drain after hepatectomy without biliary reconstruction; early oral intake with a normal diet; insulin to keep glucose below 8.3 mmol/l; PONV prophylaxis with at least two drugs; and low central venous pressure during transection with balanced crystalloid. Strong with moderate evidence: fasting 2 hours for clear fluids and 6 hours for solids, postoperative LMWH or heparin plus intermittent pneumatic compression, chlorhexidine-alcohol skin preparation, laparoscopic resection in trained teams, normothermia, early mobilisation from the day of surgery, and audit of compliance. Weaker: prehabilitation for high-risk patients 4 to 6 weeks before (weak, moderate evidence; content not established), carbohydrate loading (weak, low), preoperative methylprednisolone 500 mg (weak, moderate), antibiotic within 60 minutes before incision (weak, moderate), and immunonutrition (not recommended). NICE NG180 (2020) offers an enhanced recovery programme to everyone having elective major or complex surgery and allows clear fluids until 2 hours before.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: ERAS liver; ERAS hepatectomy; enhanced recovery liver resection; fast-track liver surgery; perioperative care for liver resection

## Connected records

- protocols: [Blood clot prevention around cancer surgery, including extended prophylaxis after major abdominal and pelvic operations](https://onco.cc/protocols/vte-prophylaxis-after-cancer-surgery/), [Enhanced recovery after colorectal cancer surgery (ERAS pathway for bowel resection)](https://onco.cc/protocols/enhanced-recovery-after-colorectal-surgery/), [Enhanced recovery after cytoreductive surgery with or without HIPEC](https://onco.cc/protocols/enhanced-recovery-after-cytoreductive-surgery-and-hipec/), [Enhanced recovery after gastrectomy (ERAS pathway for stomach cancer surgery)](https://onco.cc/protocols/enhanced-recovery-after-gastrectomy/), [Enhanced recovery after oesophagectomy (ERAS pathway for oesophageal cancer surgery)](https://onco.cc/protocols/enhanced-recovery-after-oesophagectomy/), [Enhanced recovery after pancreatoduodenectomy (ERAS pathway for the Whipple operation)](https://onco.cc/protocols/enhanced-recovery-after-pancreatoduodenectomy/), [Routine tests before planned surgery, by size of operation and fitness](https://onco.cc/protocols/routine-preoperative-tests/), [Surgical site infection prevention: skin preparation, antibiotic timing, warming and wound care](https://onco.cc/protocols/surgical-site-infection-prevention/)
- cancers: [Biliary tract cancer (cholangiocarcinoma)](https://onco.cc/cancers/cholangiocarcinoma/), [Hepatocellular carcinoma](https://onco.cc/cancers/hcc/), [Intrahepatic cholangiocarcinoma](https://onco.cc/cancers/intrahepatic-cholangiocarcinoma/)
- technologies: [Enhanced recovery (ERAS) and perioperative nutrition](https://onco.cc/technologies/eras-perioperative-nutrition/), [Prehabilitation before cancer surgery](https://onco.cc/technologies/prehabilitation/)
- terms: [Hepatectomy (liver resection)](https://onco.cc/terms/hepatectomy/), [Liver-limited metastatic bowel cancer](https://onco.cc/terms/liver-limited-metastatic-colorectal/), [Prehabilitation (the pre-treatment window)](https://onco.cc/terms/prehabilitation-term/)
- ideas: [Clear drinks until two hours before an operation, rather than nothing from midnight](https://onco.cc/ideas/idea-pu-shorter-fasting-before-surgery/), [Enhanced recovery after cancer surgery, with each element's compliance measured and fed back](https://onco.cc/ideas/idea-pu-enhanced-recovery-with-measured-compliance/)

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