PERIOPERATIVE MULTIMODAL PROGRAM OF ENHANCED RECOVERY FOLLOWING PANCREATICODUODENECTOMY.

Area of Science:

• Surgical Oncology
• Gastroenterology
• Clinical Management

Background:

• Pancreaticoduodenectomy (PD) mortality has decreased, but early postoperative complications remain high (29.5%-70%).
• Improved perioperative management strategies are needed to enhance immediate outcomes following PD.

Purpose of the Study:

• To evaluate the effectiveness of the enhanced recovery after surgery (ERAS) program versus traditional methods in perioperative management of PD patients.
• To analyze the impact of ERAS on postoperative complications, oral nutrition restoration, and length of hospital stay (LoS).

Main Methods:

• A prospective retrospective study involving 78 patients undergoing PD between 2003 and 2017.
• Patients were divided into two groups: Group I (n=39) received ERAS perioperative care (2015-2017), and Group II (n=39) received traditional care (2003-2014).
• Key outcomes measured included Clavien-Dindo complications, delayed gastric emptying (DGE), pancreatic fistula (PF), surgical wound infections, and LoS.

Main Results:

• No mortality was observed in either group.
• Group I (ERAS) showed significantly lower overall Clavien-Dindo complications (25.6% vs. 46.1%, p=0.029), DGE (15.4% vs. 35.9%, p=0.009), and surgical wound infections (5.1% vs. 17.9%, p=0.031) compared to Group II.
• Pancreatic fistula rates were similar between groups (10.2% vs. 12.8%, p=0.36).
• The ERAS group had a significantly shorter LoS (14 days vs. 18 days, p=0.012).

Conclusions:

• The enhanced recovery program (ERAS) significantly reduces the incidence of postoperative complications and length of hospital stay after pancreaticoduodenectomy.
• ERAS demonstrates feasibility and effectiveness in clinical practice for improving immediate results in PD patients.
• Implementing ERAS protocols is recommended for optimizing perioperative care in PD.