A new enhanced recovery after surgery pathway for left-sided pancreatic cancer patients after distal pancreatectomy

Abstract

Background: Pancreatic surgeries are one of the most complex surgical procedures in general surgery that require highly experienced surgical technics and intensive postoperative care. Meanwhile the application of enhanced recovery after surgery (ERAS) program in pancreatic surgery is limited. The aim of this study was to attempt a new ERAS pathway specifically for patients after distal pancreatectomy (DP). Methods:Between May 2016 and November 2016, 29 patients undergoing DP in Shanghai Ruijin Hospital pancreatic disease center received the ERAS pathway. Meanwhile 19 patients were implemented traditional care. Complications, readmissions, mortality, length of stay (LOS) and drainage-tube-off day were compared and evaluated in the two groups.Results: Median length of stay was significantly reduced (18.37±2.55 days in ERAS group; 27.42±7.60 days in the control group) and drainage-tube-off days (5.89±2.41 versus 26.68±7.35 days). And no patient discharged with a drainage tube in ERAS group compared while 7 patients (36.8%) discharged with drainage tube in the conventional group. Postoperative pancreatic fistula (POPF) rate was decreased in ERAS group but not significantly. Readmission rates, as well as mortality, did not change over time. 9 patients were found postoperative abdominal fluid collections in ERAS group, and only 2 patients were confirmed real pancreatic fistula.Conclusions: Implementing the new ERAS program for DP may contribute to a decrease of LOS and drainage-tube-off days with a promising outcome. Therefore, an ERAS pathway specifically for DP should be established.

Systematic review and meta-analysis of risk factors of postoperative pancreatic fistula after distal pancreatectomy in the era of 2016 International Study Group pancreatic fistula definition

“…Thirty-four studies were retrospective cohort studies, 2,4,14-45 three were prospective cohort studies, [46][47][48] two were randomized-controlled trials, 49,50 two were propensity matched studies (retrospective 51 and prospective 52 ), one was a retrospective matched-pair analysis, 53 and one was a case-control study. 54 performed in Japan (n = 14), 15,21,24,25,30,31,33,34,39,42,43,45,48,54 USA (n = 6), 14,17,26,35,47,51 Italy (n = 5), 20,22,27,46,52 China (n = 5), 4,32,36,38,44 Germany (n = 3), 23,40,53 Korea (n = 2), 29,36 Finland (n = 2), 37,49 France (n = 1), 28 Taiwan (n = 1), 16 Sweden (n = 1), …”

“…2,4, The weighted incidence of POPF B and C were 20.2% (95%-CI: 16.9-24.0%) and 1.6% (95%-CI: 1.2-2.2%), respectively. 2,4,16,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][37][38][39][40][41][44][45][46][49][50][51][52][53][54] Meta-analysis of risk factors…”

“…The results of quality assessment of the 43 studies are given in Supplementary Table 1. The quality of 24 studies was assessed as good, 4,17,[19][20][21][27][28][29][32][33][34]37,[40][41][42][44][45][46][48][49][50][51][52][53] while 19 studies was assessed as fair. 2,[14][15][16]18,[22][23][24][25][26]30,35,36,38,39,43,47,54,55 Studies generally performed well in six of the eight domains.…”

“…In contrast, the two domains that frequently scored poorly were comparability and selection of nonexposed cohort. On comparability, only three studies received the maximum number of points (3/43), 4,34,53 while 18 studies received 1 point (18/43), 17,[19][20][21][27][28][29]32,33,36,40,42,44,45,[48][49][50]52 and 22 studies received 0 points (22/43). 2,[14][15][16]18,[22][23][24][25][26]30,31,35,[37][38][39]41,43,46,47,51,54 Thirty-one studies were scored 0 in selection of non-exposure cohort (31/43).…”

“…2,[14][15][16]18,[22][23][24][25][26]30,31,35,[37][38][39]41,43,46,47,51,54 Thirty-one studies were scored 0 in selection of non-exposure cohort (31/43). 2,4,[14][15][16][17][18][19][20][21][22][23][24][25][26][27]29,[31][32][33][34][35][36][38][39][40][43][44][45]48,54 Statistical heterogeneity was ...…”