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Intensive perioperative rehabilitation improves surgical outcomes after pancreaticoduodenectomy

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Abstract

Purpose

Although the mortality rate for pancreaticoduodenectomy (PD) has decreased to around 2.8–5% in high-volume centers, postoperative complications are still common in 30–50% of cases. Preoperative exercise, called “prehabilitation,” has been recently reported to reduce the frequency of complications after surgery. This study aims to evaluate the impact of the intensive perioperative rehabilitation on improvement of surgical outcomes for patients undergoing PD.

Methods

Between 2003 and 2014, 576 consecutive patients underwent PD in Wakayama Medical University Hospital. Of these, 331 patients received perioperative rehabilitation combined with prehabilitation and postoperative rehabilitation between 2009 and 2014. Previously, 245 patients underwent PD without perioperative rehabilitation between 2003 and 2008. We compared surgical outcomes between the patients undergoing PD with and without perioperative rehabilitation to evaluate the efficacy of our rehabilitation program.

Results

The frequency of pulmonary complications was significantly lower in patients undergoing PD with perioperative rehabilitation than those without (0.9% vs. 4.3%, P = 0.011). There were no significant differences in other complication or mortality rates. Length of hospital stay was also shorter in patients receiving perioperative rehabilitation than that of those not receiving it (16 vs. 24 days, P < 0.001).

Conclusions

Intensive perioperative rehabilitation might reduce postoperative pulmonary complications and shorten postoperative hospital stay after PD. Therefore, we suggest that perioperative rehabilitation should be included as part of enhanced recovery after surgery for patients undergoing PD, although further large-scale studies are necessary to confirm our results.

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Acknowledgments

We would like to thank the Clinical Research Center, Wakayama Medical University, for proofreading and editing the manuscript.

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Authors and Affiliations

  1. Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan

    Yuji Kitahata, Seiko Hirono, Manabu Kawai, Ken-ichi Okada, Motoki Miyazawa, Atsushi Shimizu, Ryouhei Kobayashi, Masaki Ueno, Shinya Hayami & Hiroki Yamaue

  2. Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan

    Toshio Shimokawa

  3. Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan

    Ken Kouda & Fumihiro Tajima

Authors
  1. Yuji Kitahata
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  2. Seiko Hirono
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  3. Manabu Kawai
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Correspondence to Hiroki Yamaue.

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The authors declare that they have no conflict of interest.

Ethical statement

This study was approved by WMUH Institutional Review Board (No. 1805) with waived informed consent.

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Kitahata, Y., Hirono, S., Kawai, M. et al. Intensive perioperative rehabilitation improves surgical outcomes after pancreaticoduodenectomy. Langenbecks Arch Surg 403, 711–718 (2018). https://doi.org/10.1007/s00423-018-1710-1

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  • DOI: https://doi.org/10.1007/s00423-018-1710-1

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