Guidelines for Perioperative Care for Pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations
Kristoffer Lassen,Kristoffer Lassen,Marielle M.E. Coolsen,Karem Slim,Francesco Carli,José Eduardo de Aguilar-Nascimento,Markus Schäfer,Rowan W. Parks,Kenneth C. H. Fearon,Dileep N. Lobo,Nicolas Demartines,Marco Braga,Olle Ljungqvist,Olle Ljungqvist,Cornelis H. C. Dejong +14 more
TLDR
Evidence-based guidelines provide the necessary platform upon which to base a unified protocol for perioperative care for pancreaticoduodenectomy and facilitates multi-institutional prospective cohort registries and adequately powered randomised trials.Abstract:
Protocols for enhanced recovery provide comprehensive and evidence-based guidelines for best perioperative care. Protocol implementation may reduce complication rates and enhance functional recovery and, as a result of this, also reduce length-of-stay in hospital. There is no comprehensive framework available for pancreaticoduodenectomy. An international working group constructed within the Enhanced Recovery After Surgery (ERAS®) Society constructed a comprehensive and evidence-based framework for best perioperative care for pancreaticoduodenectomy patients. Data were retrieved from standard databases and personal archives. Evidence and recommendations were classified according to the GRADE system and reached through consensus in the group. The quality of evidence was rated “high”, “moderate”, “low” or “very low”. Recommendations were graded as “strong” or “weak”. Comprehensive guidelines are presented. Available evidence is summarised and recommendations given for 27 care items. The quality of evidence varies substantially and further research is needed for many issues to improve the strength of evidence and grade of recommendations. The present evidence-based guidelines provide the necessary platform upon which to base a unified protocol for perioperative care for pancreaticoduodenectomy. A unified protocol allows for comparison between centres and across national borders. It facilitates multi-institutional prospective cohort registries and adequately powered randomised trials.read more
Citations
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Adherence to ERAS elements in major visceral surgery—an observational pilot study
TL;DR: The results indicate a discrepancy between ERAS targets and actual practice in comorbid patients undergoing major visceral surgery, need for a prompt redefinition of ERAS mobilization targets,need for the improvement of counseling, and need for the implementation of ERas principles.
Journal ArticleDOI
Perioperative Care with Fast-Track Management in Patients Undergoing Pancreaticoduodenectomy
Shinjiro Kobayashi,Ryuiti Ooshima,Satoshi Koizumi,Masafumi Katayama,Joe Sakurai,Taiji Watanabe,Hiroshi Nakano,Toshihide Imaizumi,Takehito Otsubo +8 more
TL;DR: Perioperative care with fast-track management may reduce postoperative complications and decrease the length of hospital stay in patients undergoing pancreaticoduodenectomy.
Journal ArticleDOI
Improved Outcomes in 394 Pancreatic Cancer Resections: the Impact of Enhanced Recovery Pathway
Vandana Agarwal,Martin Thomas,Riddhi Joshi,Vikram Chaudhari,Manish S. Bhandare,Abhishek Mitra,Ashwin Desouza,Reshma Ambulkar,Shailesh V. Shrikhande +8 more
TL;DR: Improved compliance was associated with reduced major complications, mortality, and shorter stay in patients undergoing pancreatic cancer surgery in high-volume centre and ER programme is feasible and safe in resource and infrastructure limited lower middle-income country.
Journal ArticleDOI
Feasibility of an Enhanced Recovery Protocol for Elective Pancreatoduodenectomy: A Multicenter International Cohort Study.
Didier Roulin,Emmanuel Melloul,Björn Erik Wellg,Jakob R. Izbicki,Dionisios Vrochides,Mustapha Adham,Martin Hübner,Nicolas Demartines +7 more
TL;DR: Overall compliance with ERAS protocol was associated with decreased complications and length of stay, and specific ERAS elements, such as avoidance of postoperative nasogastric tube and early mobilization, independently improved outcomes.
Journal ArticleDOI
Enhanced recovery after surgery (ERAS) programs for esophagectomy
TL;DR: Analysis of the literature found that implementation of ERAS resulted in decreased costs, length of stay and pulmonary specific complication reduction, but not overall morbidity, and the evidence lacks randomized control trials.
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