Implementation of the Enhanced Recovery AfterSurgery Protocol with Orem’s Self-Care Theory in Nursing Care for a Patient with PerihilarCholangiocarcinoma: A Case Study
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Abstract: Perihilar cholangiocarcinoma (pCCA) is a common cancer in Thailand and is often diagnosed at an advanced stage. Hepatectomy is the primary treatment for patients with resectable disease; however, it is a complex surgical procedure associated with a high risk of postoperative complications. Therefore, systematic patient care is essential to prevent complications and promote postoperative recovery. The Enhanced Recovery After Surgery (ERAS) protocol has been widely implemented to reduce complications, enhance recovery, and shorten hospital length of stay. This case study aimed to analyze patients’ problems and needs, and to propose approaches for implementing ERAS protocol in combination with Orem’s Self-Care Theory to promote self-care abilities among patients with perihilar cholangiocarcinoma undergoing hepatectomy, through the role of advanced practice nurses. In this case study, patient care covered both preoperative and postoperative phases. The APN played a key role in patient assessment, evidence-based nursing care planning, preoperative counseling and preparation, postoperative complication monitoring, pain management, early mobilization promotion, and nutritional support to enhance the patient’s self-care ability. The results showed that integrating the ERAS protocol with Orem’s Self-Care Theory, implemented through the role of the Advanced Practice Nurse, effectively promoted postoperative recovery, reduced complications, and enhanced the patient’s self-care capacity.
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References
Cardinale V. Classifications and misclassification in cholangiocarcinoma. Liver International. 2019; 39(2): 260–2. doi: https://doi.org/10.1111/liv.13998.
Khan AS, Dageforde LA. Cholangiocarcinoma. Surg Clin North Am. 2019; 99(2): 315–35. doi: 10.1016/j.suc.2018.12.004.
Massarweh N, El-Serag H. Epidemiology of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Cancer control. 2017; 24: 107327481772924. doi: 10.1177/1073274817729245.
Rumgay H, Ferlay J, de Martel C, et al. Abstract 44: Global incidence of hepatocellular carcinoma and intrahepatic cholangiocarcinoma in 2018. Cancer epidemiology, biomarkers & prevention. 2021; 30(7_Supplement): 44 .doi: 10.1158/1538-7755.Asgcr21-44.
Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet. 1975; 140(2): 170–8.
Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg. 1992; 215(1): 31–8. doi: 10.1097/00000658-199201000-00005.
Shen Y, Hu Y-L, Xu J-H, et al. Incidence, risk factors, outcomes, and prediction model of surgical site infection after hepatectomy for hepatocellular carcinoma: A multicenter cohort study. European Journal of Surgical Oncology. 2025; 51(2): 109486. doi: 10.1016/j.ejso.2024.109486.
Mansueto G, Gatti FL, Boninsegna E, et al. Biliary leakage after hepatobiliary and pancreatic surgery: A classification system to guide the proper percutaneous treatment. Cardiovasc Intervent Radiol. 2020; 43(2): 302–10. doi: 10.1007/s00270-019-02374-8.
Li J, Moustafa M, Freiwald-Bibiza E, et al. Is it feasible to standardize a composite postoperative complication reporting system for liver resection? Journal of Gastrointestinal Surgery. 2020; 24(12): 2748–55. doi: https://doi.org/10.1007/s11605-019-04457-w.
Soreide JA, Deshpande R. Post hepatectomy liver failure (PHLF) - Recent advances in prevention and clinical management. Eur J Surg Oncol. 2021; 47(2): 216–24. doi: 10.1016/j.ejso.2020.09.001.
Lopez-Guerra D, Santos-Naharro J, Rojas-Holguin A, et al. Postoperative bleeding and biliary leak after liver resection: A cohort study between two different fibrin sealant patches. Sci Rep. 2019; 9(1): 12001.doi: 10.1038/s41598-019-48529-y.
Downey CL, Bainbridge J, Jayne DG, et al. Impact of in-hospital postoperative complications on quality of life up to 12 months after major abdominal surgery. Br J Surg. 2023; 110(9): 1206–12. doi: 10.1093/bjs/znad167.
Armellini A, Chew S, Johnston S, et al. The hospital costs of complications following major abdominal surgery: A retrospective cohort study. BMC Res Notes. 2024; 17(1): 59.doi: 10.1186/s13104-024-06720-z.
Kodra N, Shpata V, Ohri I. Risk factors for postoperative pulmonary complications after abdominal surgery. Open Access Maced J Med Sci. 2016; 4(2): 259–63. doi: 10.3889/oamjms.2016.059.
Ripolles-Melchor J, Ramirez-Rodriguez JM, Casans-Frances R, et al. Association between use of enhanced recovery after surgery protocol and postoperative complications in colorectal surgery: The postoperative outcomes within enhanced recovery after surgery protocol (POWER) study. JAMA Surg. 2019; 154(8): 725–36. doi: 10.1001/jamasurg.2019.0995.
Ripolles-Melchor J, Abad-Motos A, Logrono-Egea M, et al. Postoperative outcomes within enhanced recovery after surgery protocol in elective total hip and knee arthroplasty. POWER.2 study: study protocol for a prospective, multicentre, observational cohort study. Turk J Anaesthesiol Reanim. 2019; 47(3): 179–86. doi: 10.5152/TJAR.2019.87523.
Carter-Brooks CM, Du AL, Ruppert KM, et al. Implementation of a urogynecology-specific enhanced recovery after surgery (ERAS) pathway. Am J Obstet Gynecol. 2018; 219(5): 495 e1– e10. doi: 10.1016/j.ajog.2018.06.009.
Joliat GR, Kobayashi K, Hasegawa K, et al. Guidelines for perioperative care for liver surgery: Enhanced recovery after surgery (ERAS) society recommendations 2022. World J Surg. 2023; 47(1): 11–34.doi: 10.1007/s00268-022-06732-5.
Orem D. Nursing: concepts of practice. 2001;6th ed.
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Biliary Tract Cancers [Internet]. Version 1.2025. Available from: https://www.nccn.org/professionals/physician_gls/pdf/BiliaryTractCancers.pdf.
Hanucharurnkul S. Orem's nursing theory. In S. Hanucharurnkul (Ed.), Self-care: The science and art of nursing: Bangkok: V.J. Printing.; 2001. 17–55 p.
Brodersen F, Wagner J, Uzunoglu FG, et al. Impact of preoperative patient education on postoperative recovery in abdominal surgery: A systematic review. World J Surg. 2023; 47(4): 937-47. doi: 10.1007/s00268-022-06884-4.
Kundra P, Vitheeswaran M, Nagappa M, et al. Effect of preoperative and postoperative incentive spirometry on lung functions after laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2010; 20(3): 170–2. doi: 10.1097/SLE.0b013e3181db81ce.
Liu D, Zhu L, Yang C. The effect of preoperative smoking and smoke cessation on wound healing and infection in post-surgery subjects: A meta-analysis. Int Wound J. 2022; 19(8): 2101–6. doi: 10.1111/iwj.13815.
Yang L, Zhang Z, Kong J, et al. Systematic review and meta-analysis of the benefit and safety of preoperative administration of steroid in patients undergoing liver resection. Front Pharmacol. 2019; 10: 1442. doi: 10.3389/fphar.2019.01442.
Hasegawa Y, Nitta H, Takahara T, et al. Glucocorticoid use and ischemia-reperfusion injury in laparoscopic liver resection: Randomized controlled trial. Ann Gastroenterol Surg. 2020; 4(1): 76–83. doi: 10.1002/ags3.12298.
Clinical guideline for prevention and management of perioperative hypothermia [Internet]. 2023. Available from: https://www.rcat.org/_files/ugd/09122c_973768a8cc2a438d91b5ecbf8428b6fc.pdf?lang=en.
Harimoto N, Araki K, Ishii N, et al. Predictors of postoperative ascites after hepatic resection in patients with hepatocellular carcinoma. Anticancer Research. 2020; 40(8): 4343.doi: 10.21873/anticanres.14437.
Acosta L, Garcia C, Dugan A, et al. Impact of super obesity on perioperative outcomes after hepatectomy: The weight of the risk. Surgery. 2017; 162. doi: 10.1016/j.surg.2017.07.007.
Chularee S. Incidence of Post-operative Complications, Nursing Management and Outcomes in Patients at Post Anesthesia Care Unit (PACU). Journal of Nursing and Health care. 2018;35(4):194–203. Available from: https://he01.tci-thaijo.org/index.php/jnat-ned/article/view/111877.
Dieu AA-O, Huynen P, Lavand'homme P, et al. Pain management after open liver resection: Procedure-Specific Postoperative Pain Management (PROSPECT) recommendations. 2021; 46(5): 433-45. doi: 10.1136/rapm-2020-101933.
de Almeida EPM, de Almeida JP, Landoni G, et al. Early mobilization programme improves functional capacity after major abdominal cancer surgery: A randomized controlled trial. Br J Anaesth. 2017; 119(5): 900–7 .doi: 10.1093/bja/aex250.
