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Improved Outcomes in 394 Pancreatic Cancer Resections: the Impact of Enhanced Recovery Pathway

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Enhanced recovery (ER) pathway reduces morbidity and accelerates recovery. It is associated with reduced postoperative stay, morbidity, and costs. Feasibility and safety of ER programme has not been studied in developing countries. The objectives were to assess compliance with Enhanced Recovery After Surgery (ERAS) elements and to assess outcomes in pancreatic surgery.

Methods

Prospective study conducted from February 2014 to December 2016, following elective pancreatic cancer surgery. Team was educated prior to implementation of ERAS. Patients were followed up until 30 days postoperatively or discharge. Data was recorded regarding the compliance with the protocol, functional GI recovery, mobilisation, and postoperative morbidity and mortality.

Results

A total of 394 patients underwent surgery. Compliance with ER elements implemented was 84% (23–100%). Compliance > 80% with ER elements was observed in 278 patients (70.5%) and < 80% in 116 patients (29.5%). Patients with > 80% compliance have significantly lower major complications (28.7 vs. 44%, p = 0.001), mortality (2.1 vs. 6.8%, p = 0.021), and postoperative stay (11 (5–78) days vs. 15 (4–61) days, p < 0.001).

Conclusion

ER programme is feasible and safe in resource and infrastructure limited lower middle-income country. Improved compliance was associated with reduced major complications, mortality, and shorter stay in patients undergoing pancreatic cancer surgery in high-volume centre.

Trial Registration

CTRI/2015/01/005393 (www.ctri.nic.in)

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Acknowledgements

We thank the nurses, surgical, and anaesthesia trainees, physiotherapists, and nutritionists for participation in the project and Ms. Pallavi Rane for statistical inputs.

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Authors and Affiliations

  1. Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, HBNI, Dr Ernest Borges Marg, Parel, Mumbai, 400012, India

    Vandana Agarwal, Riddhi Joshi & Reshma Ambulkar

  2. Westmead Hospital Sydney, Sydney, NSW, 2145, Australia

    Martin Jose Thomas

  3. Department of Gastrointestinal Surgery, Tata Memorial Centre, HBNI, Dr Ernest Borges Marg, Parel, Mumbai, 400012, India

    Vikram Chaudhari, Manish Bhandare, Ashwin deSouza & Shailesh V. Shrikhande

  4. National Cancer Institute, Nagpur, Maharashtra, India

    Abhishek Mitra

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  1. Vandana Agarwal
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Contributions

Vandana Agarwal: concept, design, analysis, interpretation of data, approval of final draft

Martin Thomas: data acquisition, preparation of initial draft

Riddhi Joshi: data acquisition, preparation of initial draft

Vikram Chaudhari: data acquisition and verification

Manish Bhandare: data acquisition and verification, critical revision of the draft

Abhishek Mitra: data acquisition and verification

Ashwin deSouza: data acquisition and verification

Reshma Ambulkar: critical revision of the draft

Shailesh V. Shrikhande: concept, design, interpretation of data, approval of final draft

Corresponding author

Correspondence to Vandana Agarwal.

Ethics declarations

Institution review board approved the study and waived the informed consent.

Additional information

Data was presented as a poster at the American Society for Enhanced Recovery (ASER) and Evidence Based Peri-Operative Medicine (EBPOM) 2017 meeting held in Washington DC on 27th–29th April 2017.

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Agarwal, V., Thomas, M.J., Joshi, R. et al. Improved Outcomes in 394 Pancreatic Cancer Resections: the Impact of Enhanced Recovery Pathway. J Gastrointest Surg 22, 1732–1742 (2018). https://doi.org/10.1007/s11605-018-3809-7

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  • DOI: https://doi.org/10.1007/s11605-018-3809-7

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