Perioperative care with fast-track management in patients undergoing pancreaticoduodenectomy

Kobayashi, Shogo; Ooshima, Ryuiti; Koizumi, Satoshi; Katayama, Masafumi; Sakurai, Joe; Nakano, Hiroshi; Imaizumi, Tsutomu; Otsubo, Tahehito

doi:10.1016/j.pan.2013.07.244

Cited by 1 publication

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our meta-analysis included the latest 20 studies [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] from 2007 to 2019 to evaluate the safety and efficacy of ERAS in patients undergoing pancreaticoduodenectomy. Compared with the previous meta-analysis [13,14], our study covered more randomized controlled trials, thus conferring a higher grade of medical evidence to support the outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The following 27 items were included: (1) preoperative counseling, (2) perioperative biliary drainage, (3) preoperative smoking and alcohol consumption, (4) preoperative nutrition, (5) perioperative oral immunonutrition (IN), (6) oral bowel preparation, (7) preoperative fasting and preoperative treatment with carbohydrates, (8) preanesthetic medication, (9) antithrombotic prophylaxis, (10) antimicrobial prophylaxis and skin preparation, (11) epidural analgesia, (12) intravenous analgesia, (13) wound catheters and transversus abdominis plane block, ( 14 early and scheduled mobilization, and ( 27) audits. Among the included studies, 17 articles [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] that were published after 2012 had a high compliance rate with the interventions of different ERAS elements, and 3 articles [19][20][21] that were issued before 2012 met the standards of the interventions that applied more than 9 items and were also considered in our meta-analysis. The detailed elements of the ERAS approach of each study are shown in Table S3.…”

Section: Total (95% Ci)mentioning

confidence: 99%

“…A total of 18 studies [19,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] reported the incidence of delayed gastric emptying, and a total of 3157 patients were involved. Compared to the control group, the ERAS group had a significantly lower incidence of delayed gastric emptying (OR = 0:51, 95% CI: 0.42-0.63, P < 0:00001; Figure 6).…”

Section: Delayed Gastric Emptyingmentioning

confidence: 99%

“…Eight studies [23,24,26,29,[31][32][33]35] reported the length of hospital stay, and 1685 patients were involved. The current results revealed that the ERAS group had a significantly shorter length of hospital stay than the control group (WMD = −4:27, 95% CI: -4.81~-3.73, P < 0:00001; Figure 7).…”

Section: Length Of Hospital Staymentioning

confidence: 99%

“…Subgroup Analysis and Sensitivity Analysis. Subgroup analysis was performed by separately analyzing only Western countries [19-22, 24, 25, 27-30, 32, 36, 37], Eastern countries [23,26,31,[33][34][35]38], randomized controlled trials [33,35,37,38], and case-control studies [19-32, 34, 36]. All of the subgroups produced outcomes consistent with the overall outcomes, except the RCT subgroup.…”

Section: Length Of Hospital Staymentioning

confidence: 99%

See 4 more Smart Citations

The Safety and Feasibility of Enhanced Recovery after Surgery in Patients Undergoing Pancreaticoduodenectomy: An Updated Meta-Analysis

Sun

Wang

Mao

et al. 2020

BioMed Research International

View full text Add to dashboard Cite

Background. Enhanced recovery after surgery (ERAS) is a multimodal, multidisciplinary, evidence-based approach to care for surgical patients and aims at optimizing the perioperative management and outcomes. The ERAS approach was first implemented in colorectal surgery patients; however, the reported applications in pancreatoduodenectomy patients are limited. In recent years, studies on ERAS for patients undergoing pancreaticoduodenectomy have been published. The accumulation of new randomized controlled trials and high-quality case-control studies stimulated us to update the analysis. Our study comprehensively collected data to provide the best evidence summary for the clinic. Aim. To evaluate the safety and feasibility of enhanced recovery after surgery in the perioperative management of pancreatoduodenectomy patients. Methods. A systematic literature search of PubMed, Embase, and the Cochrane Library was performed up to July 2019. All randomized controlled trials and case-control studies that applied ERAS for patients undergoing pancreaticoduodenectomy were considered for inclusion in this study. The patients were divided into two groups: patients who received the ERAS perioperative management approach were defined as the ERAS group and patients who received the traditional perioperative management approach were defined as the control group. All statistical analyses were conducted using the Revman5.3 software, and the outcomes were calculated as odds ratios or weighted mean differences with their corresponding 95% confidence intervals. A funnel plot was created to assess publication bias. Subgroup and sensitivity analyses were performed to explore the sources of heterogeneity. Results. A total of 20 studies involving 3613 patients (1914 patients in the ERAS group vs. 1699 patients in the control group) were included in this study. Among the 20 studies, 4 were randomized controlled trials, and 16 were case-control studies. The overall postoperative complication rate was significantly lower in the ERAS group (OR=0.62, 95% CI: 0.53-0.74, P<0.00001) than in the control group. In addition, the minor complication rate (Clavien-Dindo I-II) was also lower in the ERAS group (OR=0.70, 95% CI: 0.58-0.86, P=0.0005). The patients in the ERAS group had a lower incidence of delayed gastric emptying (OR=0.51, 95% CI: 0.42-0.63, P<0.00001) and shorter length of hospital stay (WMD=−4.27, 95% CI: -4.81~-3.73, P<0.00001) than in the control group. The rates of pancreatic fistula (regardless of Grade A/B/C), wound infections, abdominal abscesses, readmission, reoperation, and morbidity were not significantly different between the two groups. Conclusion. The ERAS approach is safe and effective in the perioperative management of patients undergoing pancreaticoduodenectomy and helps to accelerate the postoperative recovery and improve prognosis.

show abstract