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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Clinical application of a modified pancreatojejunostomy technique for laparoscopic pancreaticoduodenectomy.
TL;DR: The modified pancreatojejunostomy technique is safe, effective and easy to manipulate and learn following LPD, and its safety and reliability are evaluated.
Journal ArticleDOI
The Outcome of Complex Hepato-Pancreato-Biliary Surgery for Elderly Patients: A Propensity Score Matching Analysis.
Kosei Takagi,Kosei Takagi,Yuzo Umeda,Ryuichi Yoshida,Daisuke Nobuoka,Takashi Kuise,Takuro Fushimi,Toshiyoshi Fujiwara,Takahito Yagi +8 more
TL;DR: Although elderly patients had more comorbidities and higher incidences of postoperative mortality and several complications before matching, their postoperative outcomes were equivalent to those of non-elderly patients after matching.
Journal ArticleDOI
Systematic review on immunonutrition in partial pancreatoduodenectomy
TL;DR: IM administration in PD can prevent the incidence of overall and infectious complications postoperatively (GRADE recommendation: moderate), however, IM has no impact on major complications, mortality, and PD-specific complications (GRGrade recommendation: low).
Journal ArticleDOI
Standardization of perioperative care facilitates safe discharge by postoperative day five after pancreaticoduodenectomy.
TL;DR: Standardizing perioperative care via enhanced recovery protocols for patients undergoing pancreaticoduodenectomy facilitates safe discharge by post-operative day five, which is three times more likely after pathway implementation.
Journal ArticleDOI
Minimally Invasive Surgical Site Infection in Procedure-Targeted ACS NSQIP Pancreaticoduodenectomies.
TL;DR: Laroscopic PD is associated with decreased surgical site infection on a national level, and this represents the first procedure-targeted National Surgical Quality Improvement Project report on this endpoint.
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