Is enhancing recovery after pancreatic cancer surgery even possible?-a narrative review

This narrative review traces the evolutionary journey of ERAS® with emphasis on challenges specific to pancreatic cancer. This article will also attempt to explore the barriers to routine ERAS® implementation and offers possible solutions to increasing its uptake and compliance rates.

Enhanced Recovery After Surgery (ERAS®) represents a paradigm shift in the perioperative management of surgical patients using a multi-modality approach each of which is based on best available evidence. ERAS® has come a long way since its inception and can now be regarded as one of the promising ways forward in the perioperative management of patients undergoing pancreatic surgery.

We identified 37 studies on the impact of ERAS® in pancreatic surgery, published over the last 2 decades. Implementation of ERAS® helped in shortening the length of stay without an increase in hospital re-admissions, morbidity, or mortality. Compliance to ERAS® is relatively low following pancreatic surgery, with a reported median compliance of 52%. Elderly patients or those with higher BMI, higher ASA scores, hypoalbuminemia, cardiac comorbidities or longer operative duration are more prone for deviations.

ERAS pathways have been successful in achieving their intended outcomes, despite low compliance. Complementing existing ERAS® pathways with prehabilitation measures, risk-stratified clinical pathways and the accessibility to step-down care facilities following discharge may facilitate its wider utilisation.