Abstract
Background
It has been considered that allowing patients to return to daily life earlier after surgery helps recovery of physiological function and reduces postoperative complications and hospital stay. We investigated the usefulness of fast-track management in perioperative care of patients undergoing pancreaticoduodenectomy (PD).
Methods
Patients (n = 90) who received conventional perioperative management from 2005 to 2009 were included as the ‘conventional group’ (historical control group), and patients who received perioperative care with fast-track management (n = 100) from 2010 to March 2013 were included as the ‘fast-track group’. To evaluate the efficacy of perioperative care with fast-track management, the incidence of postoperative complications and the length of hospital stay were compared between the two groups (comparative study). For statistical analysis, univariate analysis was performed using the χ 2 test or Fisher’s exact test.
Results
There was no significant difference between the two groups in sex, mean age, presence/absence of diabetes mellitus, preoperative drainage for jaundice, previous disease, operative procedure, mean duration of operation, or blood loss (p < 0.01). The incidence of surgical site infection in the conventional group and fast-track group was 28.9 and 14.0 %, respectively, with a significant difference between the two groups (p = 0.019). In addition, the incidence of pancreatic fistula (grade B, C) significantly differed between the two groups (27.8 % in the conventional group, 9.0 % in the fast-track group; p = 0.001). The mean postoperative hospital stay was 36.3 days in the conventional group and 21.9 days in the fast-track group (p < 0.001).
Conclusions
Perioperative care with fast-track management may reduce postoperative complications and decrease the length of hospital stay in patients undergoing PD.
Similar content being viewed by others
References
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 204:917–923
Berberat PO, Ingold H, Gulbinas A et al (2007) Fast track: different implications in pancreatic surgery. J Gastrointest Surg 11:807–880
Balzano G, Zerbi A, Braga M et al (2008) Fast-track recovery programme after pancreatico-duodenectomy reduces delayed gastric emptying. Br J Surg 95:1387–1393
Cotton P (1993) Fast-track improves CABG outcomes. JAMA 270:2023
Kehlet H, Wilmore DW (2002) Multimodal strategies to improve surgical outcome. Am J Surg 183:630–641
Kehlet H, Dahl JB (2003) Anesthesia, surgery, and challenges in postoperative recovery. Lancet 362:1921–1928
Fearon KC, Ljungqvist O, Von Meyenfeldt M et al (2005) Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 24:466–477
Wichmann MW, Roth M, Jauch KW et al (2006) A prospective clinical feasibility study for multimodal “fast track” rehabilitation in elective pancreatic cancer surgery. Rozhl Chir 85:169–175
Montiel Casado MC, Pardo SF, Rotellar SF et al (2010) Experience of a cephalic pancreatoduodenectomy fast-track program. Cir Esp 87:378–384 (in Spanish)
di Sebastiano P, Festa L, De Bonis A et al (2011) A modified fast-track program for pancreatic surgery: a prospective single-center experience. Langenbecks Arch Surg 396:345–351
Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768
Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13
Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196
Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248:189–198
Podore PC, Throop EB (1999) Infrarenal aortic surgery with a 3-day hospital stay: a report on success with a clinical pathway. J Vasc Surg 29:787–792
Cerfolio RJ, Bryant AS, Bass CS et al (2004) Fast tracking after Ivor Lewis esophagogastrectomy. Chest 126:1187–1194
Kawai M, Tani M, Terasawa H et al (2006) Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection: prospective study for 104 consecutive patients. Ann Surg 244:1–7
Bassi C, Molinari E, Malleo G et al (2010) Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg 252:207–214
Seiler CA, Wagner M, Bachmann T et al (2005) Randomized clinical trial of pylorus-preserving duodenopancreatectomy versus classical Whipple resection: long term results. Br J Surg 92:547–556
DeOliveira ML, Winter JM, Schafer M et al (2006) Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 244:931–937
Balzano G, Zerbi A, Braga M et al (2008) Fast-track recovery programme after pancreatico-duodenectomy reduces delayed gastric emptying. Br J Surg 95:1387–1393
Lassen K, Coolsen MM, Slim K et al (2012) Guidelines for perioperative care for pancreaticoduodenectomy: enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr 31:817–830
Egbert LD, Battit GE, Welch CE et al (1964) Reduction of postoperative pain by encouragement and instruction of patients. A study of doctor–patient rapport. N Engl J Med 270:825–827
Kiecolt-Glaser JK, Page GG, Marucha PT et al (1998) Psychological influences on surgical recovery. Perspectives from psychoneuroimmunology. Am Psychol 53:1209–1218
Slim K, Vicaut E, Panis Y et al (2004) Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation. Br J Surg 91:1125–1130
Sanders G, Mercer SJ, Saeb-Parsey K et al (2001) Randomized clinical trial of intravenous fluid replacement during bowel preparation for surgery. Br J Surg 88:1363–1365
Eriksson LI, Sandin R (1996) Fasting guidelines in different countries. Acta Anaesthesiol Scand 40:971–974
Søreide E, Fasting S, Raeder J (1997) New preoperative fasting guidelines in Norway. Acta Anaesthesiol Scand 41:799
No authors listed (1999) Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: a report by the American Society of Anesthesiologist Task Force on Preoperative Fasting. Anesthesiology 90:896–905
Grantcharov TP, Rosenberg J (2001) Vertical compared with transverse incisions in abdominal surgery. Eur J Surg 167:260–267
Urbach DR, Kennedy ED, Cohen MM (1999) Colon and rectal anastomoses do not require routine drainage: a systematic review and meta-analysis. Ann Surg 229:174–180
Conlon KC, Labow D, Leung D et al (2001) Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg 234:487–493
Mangram AJ, Horan TC, Pearson ML et al (1999) Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20:250–278
Kawai M, Kondo S, Yamaue H et al (2011) Predictive risk factors for clinically relevant pancreatic fistula analyzed in 1,239 patients with pancreaticoduodenectomy: multicenter data collection as a project study of pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci 18:601–608
Wind J, Hofland J, Preckel B et al (2006) Perioperative strategy in colonic surgery: laparoscopy and/or fast track multimodal management versus standard care (LAFA trial). BMC Surg 6:16
CarloV Di, Zerbi A, Balzano G et al (1999) Pylorus-preserving pancreaticoduodenectomy versus conventional whipple operation. World J Surg 23:920–925
Hirata K, Sato T, Mukaiya M et al (1997) Results of 1001 pancreatic resections for invasive ductal adenocarcinoma of the pancreas. Arch Surg 132:771–776
Balzano G, Zerbi A, Braga M et al (2008) Fast-track recovery programme after pancreatico-duodenectomy reduces delayed gastric emptying. Br J Surg 95:1387–1393
Miyata H, Yano M, Yasuda T et al (2012) Randomized study of clinical effect of enteral nutrition support during neoadjuvant chemotherapy on chemotherapy-related toxicity in patients with esophageal cancer. Clin Nutr 31:330–336
Aiko S, Yoshizumi Y, Tsuwano S et al (2005) The effects of immediate enteral feeding with a formula containing high levels of omega-3 fatty acids in patients after surgery for esophageal cancer. JPEN J Parenter Enteral Nutr 29:141–147
Heys SD, Walker LG, Smith I et al (1999) Enteral nutritional supplementation with key nutrients in patients with critical illness and cancer: a meta-analysis of randomized controlled clinical trials. Ann Surg 229:467–477
Watanabe S, Shiratori K, Takeuchi T et al (1986) Release of cholecystokinin and exocrine pancreatic secretion in response to an elemental diet in human subjects. Dig Dis Sci 31:919–924
Novis BH, Bank S, Marks IN (1972) Exocrine pancreatic function in intestinal malabsorption and small bowel disease. Am J Dig Dis 17:489–494
Srinarmwong C, Luechakiettisak P, Prasitvilai W (2008) Standard Whipple’s operation versus pylorus preserving pancreaticoduodenectomy: a randomized controlled trial study. J Med Assoc Thai 91:693–698
Winter JM, Cameron JL, Campbell KA et al (2006) Does pancreatic duct stenting decrease the rate of pancreatic fistula following pancreaticoduodenectomy? Results of a prospective randomized trial. J Gastrointest Surg 10:1280–1290
Tani M, Kawai M, Hirono S et al (2010) A prospective randomized controlled trial of internal versus external drainage with pancreaticojejunostomy for pancreaticoduodenectomy. Am J Surg 199:759–764
Grant Support
None.
Conflict of interest
The authors declare that they have no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kobayashi, S., Ooshima, R., Koizumi, S. et al. Perioperative Care with Fast-Track Management in Patients Undergoing Pancreaticoduodenectomy. World J Surg 38, 2430–2437 (2014). https://doi.org/10.1007/s00268-014-2548-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-014-2548-5