Updates in Surgery

, Volume 68, Issue 3, pp 253–255 | Cite as

ERAS and pancreatic surgery: a review

  • J. Perinel
  • M. Adham
Review Article
Part of the following topical collections:
  1. Pancreatic Surgery


Pancreatic surgery is still considered as a high-risk abdominal surgery. While the mortality rate is low, the morbidity remains high ranging from 30 to 60%. In 2012, the ERAS study group published the official recommendations to implement the enhanced recovery after surgery (ERAS) program in patients undergoing PD. Non-randomized studies have shown that ERAS was safe and feasible. They reported a significantly shortened LOS with lower morbidity in ERAS group. However, the level of evidence remains low due to absence of randomized study and because of a substantial heterogeneity in the content of ERAS protocols. Future studies should be prospective, multicentric and designed with a structured implementation of standardized ERAS pathway.


Enhanced recovery after surgery ERAS Pancreatectomy Pancreatic surgery 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The article is in accordance with ethical standards.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.


  1. 1.
    Kehlet H (1997) Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78:606–617CrossRefPubMedGoogle Scholar
  2. 2.
    Anderson AD, McNaught CE, MacFie J et al (2003) Randomized clinical trial of multimodal optimization and standard perioperative surgical care. Br J Surg 90:1497–1504CrossRefPubMedGoogle Scholar
  3. 3.
    Varadhan KK, Neal KR, Dejong CH et al (2010) The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutrit 29(4):434–440CrossRefGoogle Scholar
  4. 4.
    Spanjersberg WR, Reurings J, Keus F, et al (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database of System Rev (2):CD007635Google Scholar
  5. 5.
    Gouma DJ, van Geenen RC, van Gulik TM et al (2000) Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg 232:786–795CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Winter JM, Cameron JL, Campbell KA et al (2006) 1423 pan- creaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 10(9):1199–1210 (discussion 1210–1211) Google Scholar
  7. 7.
    Balzano G, Zerbi A, Capretti G et al (2008) Effect of hospital volume on the outcome of pancreaticoduodenectomy in Italy. Br J Surg 95:357–362CrossRefPubMedGoogle Scholar
  8. 8.
    Coolsen MM, van Dam RM, van der Wilt AA, Slim K, Lassen K, Dejong CH (2013) Systematic review and meta-analysis of enhanced recovery after pancreatic surgery with particular emphasis on pancreaticoduodenectomies. World J Surg 37:1909–1918CrossRefPubMedGoogle Scholar
  9. 9.
    Maessen J, Dejong CH, Hausel J, Nygren J, Lassen K et al (2007) A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg 94:224–231CrossRefPubMedGoogle Scholar
  10. 10.
    Balzano G, Zerbi A, Braga M et al (2008) Fast-track recovery programme after pancreaticoduodenectomy reduces delayed gastric emptying. Br J Surg 95(11):387–393CrossRefGoogle Scholar
  11. 11.
    Porter GA, Pisters PWT, Mansyur C et al (2000) Cost and utilization impact of a clinical pathway for patients undergoing pancreaticoduodenectomy. Ann Surg Oncol 7:484–489CrossRefPubMedGoogle Scholar
  12. 12.
    Vanounou T, Pratt W, Fischer JE et al (2007) Deviation-based cost modelling: a novel model to evaluate the clinical and economic impact of clinical pathways. J Am Coll Surg 204:570–579CrossRefPubMedGoogle Scholar
  13. 13.
    Kennedy EP, Rosato EL, Sauter PK et al (2007) Initiation of a critical pathway for pancreaticoduodenectomy at an academic institution: the first step in multidisciplinary team building. J Am Coll Surg 204:917–923CrossRefPubMedGoogle Scholar
  14. 14.
    Kennedy E, Grenda T, Sauter P et al (2009) Implementation of a critical pathway for distal pancreatectomy at an academic institution. J Gastrointest Surg 13:938–944CrossRefPubMedGoogle Scholar
  15. 15.
    Nikfarjam M, Weinberg L, Low N et al (2013) A fast track recovery programme significantly reduces hospital length of stay following uncomplicated pancreaticoduodenectomy. JOP 14:63–70PubMedGoogle Scholar
  16. 16.
    Abu Hilal M, Di Fabio F, Badran A et al (2013) Implementation of enhanced recovery programme after pancreatoduodenectomy: a single-centre UK pilot study. Pancreatology 13:58–62CrossRefPubMedGoogle Scholar
  17. 17.
    Coolsen MM, van Dam RM, Chigharoe A et al (2014) Improving outcomes after Pancreaticoduodenectomy: experiences with implementing an enhanced recovery after surgery (ERAS) program. Digest Surg 31:177–184CrossRefGoogle Scholar
  18. 18.
    Robertson N, Gallacher PJ, Peel N et al (2012) Implementation of an enhanced recovery programme following pancreaticoduodenectomy. HPB 14:700–708CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kagedan DJ, Ahmed M, Devitt KS et al (2015) Enhanced recovery after pancreatic surgery: a systematic review of the evidence. HPB (Oxford) 17(1):11–16Google Scholar
  20. 20.
    ERAS Compliance Group (2015) The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg 261(6):1153–1159CrossRefGoogle Scholar
  21. 21.
    Braga M, Pecorelli N, Ariotti R et al (2014) Enhanced recovery after surgery pathway in patients undergoing pancreaticoduodenectomy. World J Surg 38:2960–2966CrossRefPubMedGoogle Scholar
  22. 22.
    Pearsall EA, Meghji Z, Pitzul KB et al (2015) A qualitative study to understand the barriers and enablers in implementing an enhanced recovery after surgery program. Ann Surg 261(1):92–96CrossRefPubMedGoogle Scholar

Copyright information

© Italian Society of Surgery (SIC) 2016

Authors and Affiliations

  1. 1.Hospices Civils de Lyon & Lyon Sud Faculty of Medicine, UCBL1E Herriot Hospital, Department of Digestive SurgeryLyon Cedex 03France

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