Perioperative Care with Fast‐Track Management in Patients Undergoing Pancreaticoduodenectomy

Abstract

Perioperative care with fast-track management may reduce postoperative complications and decrease the length of hospital stay in patients undergoing PD.

Enhanced Recovery After Surgery Program in Patients Undergoing Pancreaticoduodenectomy

“…All the included studies were retrospective case–control series. Eleven studies 11 – 13 , 24 – 27 , 30 , 34 – 36 were conducted in Western populations, and 8 studies 11 – 13 , 26 – 28 , 30 , 31 had sample sizes >100. A total of 2719 patients were included with 1409 and 1310 patients in the ERAS group and CPC group, respectively.…”

“…A total of 2719 patients were included with 1409 and 1310 patients in the ERAS group and CPC group, respectively. There were 12 studies 11 – 13 , 24 – 26 , 28 , 29 , 31 , 34 – 36 with MINORS scores ≥13.…”

“…In 6 studies 11 , 24 , 29 , 30 , 35 , 36 only PD was performed, while PPPD was used as well as PD in 8 studies. 12 , 13 , 25 – 28 , 31 , 34 One Japanese study 28 included both PPPD and subtotal stomach-preserving PD alongside PD. Eleven studies 13 , 24 , 26 – 31 , 34 – 36 used the ISGPF definition for POPF.…”

“…Kennedy et al 11 defined POPF as drainage of >30 mL with serum amylase level >3-fold for more than 10 days after surgery, while the diagnostic criteria were not described in the remaining 2 studies. 12 , 25 Eight studies 7 , 24 , 28 – 31 , 35 , 36 defined DGE as per ISGPS guidance, 3 studies 11 , 13 , 26 defined it as a need for nasogastric decompression, persistent vomiting or vomiting occurring after the 10th postoperative day, and the remaining 3 studies 12 , 25 , 34 did not state their criteria.…”

First results from the Swedish National Pancreatic and Periampullary Cancer Registry

“…Several ERP reports have shown decreased LOS, including Swedish ones. [25][26][27] Adherence to national guidelines of pathology reporting has increased and, consequently, the frequency of radical resections has decreased. 28,29 Patients with non-resectable cancer received fewer bypass surgeries over time, which could be an effect of reports showing increases in morbidity, total LOS, and costs associated with open surgical palliative procedures compared to minimally invasive strategies handling biliodigestive obstruction and gastric outlet syndrome on demand.…”