Feasibility of Enhanced Recovery after Surgery Program in the Perioperative Management of Pancreaticoduodenectomy

  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.