Article

World Journal of Surgery

, Volume 37, Issue 2, pp 240-258

First online:

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

  • Kristoffer LassenAffiliated withDepartment of GI and HPB Surgery, University Hospital Northern Norway, Tromsø and Institute of Clinical Medicine, University of TromsøClinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh Email author 
  • , Marielle M. E. CoolsenAffiliated withDepartment of Surgery, University Hospital Maastricht and NUTRIM School for Nutrition, Toxicology and Metabolism
  • , Karem SlimAffiliated withDepartment of Digestive Surgery, Hospital CHU Estaing
  • , Francesco CarliAffiliated withDepartment of Anesthesia, McGill University Health Centre
  • , José E. de Aguilar-NascimentoAffiliated withDepartment of Surgery, Federal University of Mato Grosso
  • , Markus SchäferAffiliated withDepartment of Visceral Surgery, University Hospital of Lausanne (CHUV)
  • , Rowan W. ParksAffiliated withClinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh
  • , Kenneth C. H. FearonAffiliated withClinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh
  • , Dileep N. LoboAffiliated withDivision of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre National Institute for Health Research Biomedical Research Unit, Nottingham University Hospitals, Queen’s Medical Centre
    • , Nicolas DemartinesAffiliated withDepartment of Visceral Surgery, University Hospital of Lausanne (CHUV)
    • , Marco BragaAffiliated withSan Raffaele University
    • , Olle LjungqvistAffiliated withDepartment of Surgery, Örebro University HospitalDepartment of Molecular Medicine and Surgery, Karolinska Institutet
    • , Cornelis H. C. DejongAffiliated withDepartment of Surgery, University Hospital Maastricht and NUTRIM School for Nutrition, Toxicology and Metabolism

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.