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

Abstract

Introduced by Kehlet et al. in 1997 (1), Enhanced Recovery After Surgery (ERAS®) is a holistic, multi-pronged, interdisciplinary framework which utilizes evidence-based practices to decrease surgical stress, maintain physiologic homeostasis, and facilitate recovery of patients (2). Pioneering work by Kehlet et al. (3) showed that patients undergoing open sigmoid resection could be discharged in 2 days, at a time when the average length of stay was around 10 days in most of the centres. The concept survived initial scepticism, and its acceptance increased as it became evident that outcomes improved with standardized implementation of ERAS® protocols (4). Encouraged by the dramatic reduction in hospital stay, without compromising patient outcomes, and an increase in functional recovery following

Global Perceptions on ERAS® in Pancreatoduodenectomy

“…Over the years, there have been numerous attempts to improve the peri-operative experience of the patients using [19,20]. ERAS Ò protocols were integrated into post-pancreatectomy care [4,5] with an emphasis on creation of a supportive environment which not only ameliorates surgical stress, but also enables an optimal peri-operative experience for the patient [21].…”

Effect of body fat mass loss on prognosis of radical resection for pancreatic ductal adenocarcinoma based on bioelectrical impedance analysis

“…Current prehabilitaton programs for patients undergoing pancreatic resection include diverse exercise regimens, and there is no consensus regarding timing or length of prehabilitation; thus, there is a need to establish standardized prehabilitation programs in pancreatic surgery. Moreover, the importance of preoperative immunonutrition [34], pancreatic enzyme replacement therapy [35,36], and enhanced recovery after surgery protocols [37] for patients with PDAC has been emphasized. This study had some limitations.…”