, Volume 37, Issue 2, pp 240-258
Date: 07 Sep 2012

Guidelines for Perioperative Care for Pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations

Abstract

Background

Protocols for enhanced recovery provide comprehensive and evidence-based guidelines for best perioperative care. Protocol implementation may reduce complication rates and enhance functional recovery and, as a result of this, also reduce length-of-stay in hospital. There is no comprehensive framework available for pancreaticoduodenectomy.

Methods

An international working group constructed within the Enhanced Recovery After Surgery (ERAS®) Society constructed a comprehensive and evidence-based framework for best perioperative care for pancreaticoduodenectomy patients. Data were retrieved from standard databases and personal archives. Evidence and recommendations were classified according to the GRADE system and reached through consensus in the group. The quality of evidence was rated “high”, “moderate”, “low” or “very low”. Recommendations were graded as “strong” or “weak”.

Results

Comprehensive guidelines are presented. Available evidence is summarised and recommendations given for 27 care items. The quality of evidence varies substantially and further research is needed for many issues to improve the strength of evidence and grade of recommendations.

Conclusions

The present evidence-based guidelines provide the necessary platform upon which to base a unified protocol for perioperative care for pancreaticoduodenectomy. A unified protocol allows for comparison between centres and across national borders. It facilitates multi-institutional prospective cohort registries and adequately powered randomised trials.

This work was conducted on behalf of ERAS® Society, the European Society for Clinical Nutrition and Metabolism and the International Association for Surgical Metabolism and Nutrition.
The guidelines are published as a joint effort between the Enhanced Recovery After Surgery (ERAS) Society, for Perioperative Care, The European Society for Clinical Nutrition and Metabolism (ESPEN) and The International Association for Surgical Metabolism and Nutrition (IASMEN) and copyrights for this publication is shared between the three societies. The guidelines are published jointly in World Journal of Surgery (IASMEN) and Clinical Nutrition (ESPEN), and will also be available on the ESPEN (http://www.espen.org) and ERAS Society website (http://www.erassociety.org).