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Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019

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Abstract

Background

Enhanced recovery after surgery (ERAS) pathways are now implemented worldwide with strong evidence that adhesion to such protocol reduces medical complications, costs and hospital stay. This concept has been applied for pancreatic surgery since the first published guidelines in 2012. This study presents the updated ERAS recommendations for pancreatoduodenectomy (PD) based on the best available evidence and on expert consensus.

Methods

A systematic literature search was conducted in three databases (Embase, Medline Ovid and Cochrane Library Wiley) for the 27 developed ERAS items. Quality of randomized trials was assessed using the Consolidated Standards of Reporting Trials statement checklist. The level of evidence for each item was determined using the Grading of Recommendations Assessment Development and Evaluation system. The Delphi method was used to validate the final recommendations.

Results

A total of 314 articles were included in the systematic review. Consensus among experts was reached after three rounds. A well-implemented ERAS protocol with good compliance is associated with a reduction in medical complications and length of hospital stay. The highest level of evidence was available for five items: avoiding hypothermia, use of wound catheters as an alternative to epidural analgesia, antimicrobial and thromboprophylaxis protocols and preoperative nutritional interventions for patients with severe weight loss (> 15%).

Conclusions

The current updated ERAS recommendations for PD are based on the best available evidence and processed by the Delphi method. Prospective studies of high quality are encouraged to confirm the benefit of current updated recommendations.

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  1. Department of Visceral Surgery, University Hospital Lausanne (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Emmanuel Melloul, Didier Roulin, Fabian Grass & Nicolas Demartines

  2. Department of Hepatobiliary and Pancreatic Surgery, Oslo University Hospital, Oslo, Norway

    Kristoffer Lassen

  3. Service de chirurgie Digestive, Hôpital Edouard Herriot, Hospices Civils De Lyon, Lyon, France

    Julie Perinel & Mustapha Adham

  4. Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, 20246, Hamburg, Germany

    Erik Björn Wellge & Jakob R. Izbicki

  5. Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA

    Filipe Kunzler & Horacio Asbun

  6. Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

    Marc G. Besselink

  7. Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK

    Michael J. Scott

  8. Departments of Surgery, Maastricht University, Maastricht, The Netherlands

    Cornelis H. C. Dejong

  9. Division of Hepatopancreatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA

    Dionisos Vrochides

  10. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Thomas Aloia

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  1. Emmanuel Melloul
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  2. Kristoffer Lassen
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  3. Didier Roulin
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  4. Fabian Grass
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  5. Julie Perinel
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  6. Mustapha Adham
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  7. Erik Björn Wellge
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  8. Filipe Kunzler
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  9. Marc G. Besselink
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  10. Horacio Asbun
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  11. Michael J. Scott
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  12. Cornelis H. C. Dejong
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  13. Dionisos Vrochides
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  14. Thomas Aloia
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  15. Jakob R. Izbicki
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  16. Nicolas Demartines
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Correspondence to Nicolas Demartines.

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Melloul, E., Lassen, K., Roulin, D. et al. Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019. World J Surg 44, 2056–2084 (2020). https://doi.org/10.1007/s00268-020-05462-w

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