Langenbeck's Archives of Surgery

, Volume 403, Issue 6, pp 711–718 | Cite as

Intensive perioperative rehabilitation improves surgical outcomes after pancreaticoduodenectomy

  • Yuji Kitahata
  • Seiko Hirono
  • Manabu Kawai
  • Ken-ichi Okada
  • Motoki Miyazawa
  • Atsushi Shimizu
  • Ryouhei Kobayashi
  • Masaki Ueno
  • Shinya Hayami
  • Toshio Shimokawa
  • Ken Kouda
  • Fumihiro Tajima
  • Hiroki YamaueEmail author



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.


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.


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).


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.


Perioperative rehabilitation Prehabilitation Pancreaticoduodenectomy Postoperative complication ERAS 



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

Compliance with ethical standards

Conflict of interest

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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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Yuji Kitahata
    • 1
  • Seiko Hirono
    • 1
  • Manabu Kawai
    • 1
  • Ken-ichi Okada
    • 1
  • Motoki Miyazawa
    • 1
  • Atsushi Shimizu
    • 1
  • Ryouhei Kobayashi
    • 1
  • Masaki Ueno
    • 1
  • Shinya Hayami
    • 1
  • Toshio Shimokawa
    • 2
  • Ken Kouda
    • 3
  • Fumihiro Tajima
    • 3
  • Hiroki Yamaue
    • 1
    Email author
  1. 1.Second Department of Surgery, School of MedicineWakayama Medical UniversityWakayamaJapan
  2. 2.Clinical Study Support CenterWakayama Medical UniversityWakayamaJapan
  3. 3.Department of Rehabilitation MedicineWakayama Medical UniversityWakayamaJapan

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