ERAS and pancreatic surgery: a review

Area of Science:

• Surgical Oncology
• Gastroenterology
• Clinical Pathways

Background:

• Pancreatic surgery, specifically pancreaticoduodenectomy (PD), is a high-risk procedure with significant patient morbidity (30-60%).
• Enhanced Recovery After Surgery (ERAS) programs were recommended for PD patients in 2012 to improve outcomes.
• Previous non-randomized studies suggest ERAS is safe and feasible, reducing length of stay (LOS) and morbidity.

Purpose of the Study:

• To evaluate the effectiveness and safety of ERAS programs in patients undergoing pancreaticoduodenectomy.
• To assess the impact of ERAS on patient morbidity and length of hospital stay.

Main Methods:

• Review of non-randomized studies investigating ERAS implementation in pancreatic surgery.
• Analysis of reported outcomes including morbidity rates and length of stay.

Main Results:

• Non-randomized studies indicate ERAS is associated with a significantly shortened LOS.
• ERAS implementation in PD patients has been linked to reduced morbidity.
• A substantial heterogeneity in ERAS protocol content exists across studies.

Conclusions:

• ERAS programs appear safe and feasible for pancreaticoduodenectomy.
• The current evidence level is limited due to the lack of randomized controlled trials.
• Future research should focus on prospective, multicentric studies with standardized ERAS pathways.