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Article Navigation >  Medical Journal of Peking Union Medical College Hospital  > 2018  >  9(6): 533-538
Meng-hua DAI, Shun-da WANG, Cheng XING, Tai-ping ZHANG, Quan LIAO, Jun-chao GUO, Xian-lin HAN, Qiang XU, Wen-ming WU, Yu-pei ZHAO. Feasibility of Enhanced Recovery after Surgery Program in the Perioperative Management of Pancreaticoduodenectomy[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(6): 533-538. doi: 10.3969/j.issn.1674-9081.2018.06.009
Citation: Meng-hua DAI, Shun-da WANG, Cheng XING, Tai-ping ZHANG, Quan LIAO, Jun-chao GUO, Xian-lin HAN, Qiang XU, Wen-ming WU, Yu-pei ZHAO. Feasibility of Enhanced Recovery after Surgery Program in the Perioperative Management of Pancreaticoduodenectomy[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(6): 533-538. doi: 10.3969/j.issn.1674-9081.2018.06.009
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Feasibility of Enhanced Recovery after Surgery Program in the Perioperative Management of Pancreaticoduodenectomy

doi: 10.3969/j.issn.1674-9081.2018.06.009

  • Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

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  • Corresponding author: ZHAO Yu-pei   E-mail:zhao8028@263.net
  • Received Date: 2018-09-11
  • Publish Date: 2018-11-30
    Abstract
  •   Objective   The aim of this study was to explore the safety and effectiveness of enhanced recovery after surgery (ERAS) in perioperative management of pancreaticoduodenectomy.   Methods   Among the patients undergoing pancreaticoduodenectomy from April 2016 to April 2018 in the Department of General Surgery of Peking Union Medical College Hospital, 63 patients who met the inclusion and exclusion criteria were enrolled in ERAS group and the other 60 patients in the control group. The perioperative parameters, postoperative complications, and clinical outcomes were compared between the two groups.   Results   There was no difference between the ERAS group and the control group in baseline data. The operative approach of the ERAS group was mainly laparoscopicsurgery and that of the control group was mainly open surgery (P < 0.01). The operation time in ERAS group was longer than that in control group (P < 0.01) while the intraoperative blood loss was significantly reduced (P < 0.01). Compared with the control group, the ERAS group had the shorter time of gastric tube removal, earlier postoperative fluid intake, shorter postoperative hospital stay, and significantly less hospitalization expenses (all P < 0.05). The incidence of delayed gastric emptying of the ERAS group was significantly lower than that of the control group (3.2% vs. 13.3%, P < 0.05). There was no significant difference in the incidence of total complications, pancreatic fistula, biliary fistula, postoperative hemorrhage, secondary hospital admission, secondary surgery, and death between the two groups. In the ERAS group, the intraoperative blood loss (P < 0.01), postoperative hospital stays (P < 0.05), and the hospitalization expenses (P < 0.05) of the laparoscopic subgroup were significantly lower than those of the open subgroup.   Conclusion   ERAS is safe and effective for the perioperative management of pancreaticoduodenectomy, which can significantly accelerate the recovery of patients without increasing the risk of complications.
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  • [1] Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation[J]. Br J Anaesth, 1997, 78:606-617. doi:  10.1093/bja/78.5.606
    [2] Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome[J]. Am J Surg, 2002, 183:630-641. doi:  10.1016/S0002-9610(02)00866-8
    [3] Varadhan KK, Neal KR, Dejong CH, et al. The enhanced recovery after surgery (ERAS) pathway for patients undergo-ing major elective open colorectal surgery:a meta-analysis of randomized controlled trials[J]. Clin Nutr, 2010, 29:434-440. doi:  10.1016/j.clnu.2010.01.004
    [4] 江志伟, 李宁.结直肠手术应用加速康复外科中国专家共识(2015版)[J].中国实用外科杂志, 2015, 8:841-843. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgsywkzz201508012
    [5] Karran A, Wheat J, Chan D, et al. Propensity score analysis of an enhanced recovery programme in upper gastrointestinal cancer surgery[J]. World J Surg, 2016, 40:1645-1654. doi:  10.1007/s00268-016-3473-6
    [6] Lassen K, Coolsen MM, Slim K, et al. Guidelines for perioperative care for pancreaticoduodenectomy:Enhanced Reco-very After Surgery (ERAS(R)) Society recommendations[J]. Clin Nutr, 2012, 31:817-830. doi:  10.1016/j.clnu.2012.08.011
    [7] Mezhir JJ. Management of complications following pancreatic resection:an evidence-based approach[J]. J Surg Oncol, 2013, 107:58-66. doi:  10.1002/jso.23139
    [8] Balcom JT, Rattner DW, Warshaw AL, et al. Ten-year experience with 733 pancreatic resections:changing indications, older patients, and decreasing length of hospitalization[J]. Arch Surg, 2001, 136:391-398. doi:  10.1001/archsurg.136.4.391
    [9] Kennedy EP, Rosato EL, Sauter PK, et al. Initiation of a critical pathway for pancreaticoduodenectomy at an academic institution-the first step in multidisciplinary team building[J]. J Am Coll Surg, 2007, 204:917-924. doi:  10.1016/j.jamcollsurg.2007.01.057
    [10] 陈凛, 陈亚进, 董海龙.加速康复外科中国专家共识及路径管理指南(2018版)[J].中国实用外科杂志, 2018, 1:1-20. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgsywkzz201801001
    [11] Balzano G, Zerbi A, Braga M, et al. Fast-track recovery programme after pancreatico- duodenectomy reduces delayed gastric emptying[J]. Br J Surg, 2008, 95:1387-1393. doi:  10.1002/bjs.6324
    [12] Williamsson C, Karlsson N, Sturesson C, et al. Impact of a fast-track surgery programme for pancreaticoduodenectomy[J]. Br J Surg, 2015, 102:1133-1141. doi:  10.1002/bjs.9856
    [13] Bai X, Zhang X, Lu F, et al. The implementation of an enhanced recovery after surgery (ERAS) program following pancreatic surgery in an academic medical center of China[J]. Pancreatology, 2016, 16:665-670. doi:  10.1016/j.pan.2016.03.018
    [14] Dai J, Jiang Y, Fu D. Reducing postoperative complications and improving clinical outcome:Enhanced recovery after surgery in pancreaticoduodenectomy:A retrospective cohort study[J]. Int J Surg, 2017, 39:176-181. doi:  10.1016/j.ijsu.2017.01.089
    [15] Deng X, Cheng X, Huo Z, et al. Modified protocol for enhanced recovery after surgery is beneficial for Chinese cancer patients undergoing pancreaticoduodenectomy[J]. Oncotarget, 2017, 8:47841-47848. doi:  10.18632/oncotarget.18092
    [16] Hu HL, Zhou XD, Zhang Q, et al. Factors influencing delayed gastric emptying after pancreaticoduodenectomy-a meta-analysis[J]. Hepatogastroenterology, 2014, 61:1539-1545. http://www.ncbi.nlm.nih.gov/pubmed/25436339
    [17] Luckey A, Livingston E, Tache Y. Mechanisms and treatment of postoperative ileus[J]. Arch Surg, 2003, 138:206-214. doi:  10.1001/archsurg.138.2.206
    [18] Gerritsen A, Besselink MG, Gouma DJ, et al. Systematic review of five feeding routes after pancreatoduodenectomy[J]. Br J Surg, 2013, 100:589-599. doi:  10.1002/bjs.9049
    [19] Marquez ME, Baz FC, Suarez JP, et al. Nutrition management in enhanced recovery after abdominal pancreatic surgery[J]. Cir Esp, 2017, 95:361-368. doi:  10.1016/j.ciresp.2017.06.004
    [20] Delitto D, Luckhurst CM, Black BS, et al. Oncologic and perioperative outcomes following selective application of laparoscopic pancreaticoduodenectomy for periampullary malignancies[J]. J Gastrointest Surg, 2016, 20:1343-1349. doi:  10.1007/s11605-016-3136-9
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