Kosei Takagi1, Ryuichi Yoshida2, Takahito Yagi3, Yuzo Umeda4, Daisuke Nobuoka5, Takashi Kuise6, Shiro Hinotsu7, Takashi Matsusaki8, Hiroshi Morimatsu9, Jun Eguchi10, Jun Wada11, Masuo Senda12, Toshiyoshi Fujiwara13. 1. Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. Electronic address: kotakagi15@gmail.com. 2. Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. Electronic address: r9232001@yahoo.co.jp. 3. Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. Electronic address: twin1957yagi2000@yahoo.co.jp. 4. Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. Electronic address: y.umeda@d9.dion.ne.jp. 5. Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. Electronic address: pcx41cax@cc.okayama-u.ac.jp. 6. Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. Electronic address: kuisetaka@yahoo.co.jp. 7. Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan. Electronic address: hinotsus@okayama-u.ac.jp. 8. Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan. Electronic address: matusakik@ybb.ne.jp. 9. Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan. Electronic address: pb9b45wr@okayama-u.ac.jp. 10. Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. Electronic address: jjeguchi@gmail.com. 11. Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. Electronic address: junwada@okayama-u.ac.jp. 12. Division of Physical Medicine and Rehabilitation, Okayama University Hospital, Okayama, Japan. Electronic address: senda@md.okayama-u.ac.jp. 13. Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. Electronic address: toshi_f@md.okayama-u.ac.jp.
Abstract
BACKGROUND & AIMS: Evidence of the advantages of enhanced recovery after surgery (ERAS) protocols following pancreaticoduodenectomy (PD) is limited. The aim of this study was to examine the efficiency of ERAS protocols in patients following PD. METHODS:Between June 2014 and October 2016, patients undergoing PD were randomly assigned to receive ERAS protocols or standard care. The primary endpoint was the postoperative length of stay. Secondary endpoints included postoperative complications, postoperative quality-of-life (QoR-40J), readmission, and medical cost. RESULTS: Of 80 eligible patients, 74 were analyzed in intention-to-treat principles: 37 in the control group and 37 in the ERAS group. The mean length of stay in the ERAS group was significantly shorter than that in the control group (20.1 ± 5.4 vs 26.9 ± 13.5 days, P < 0.001). The ERAS group had a significantly lower percentage of postoperative complications (32.4% vs 56.8%, P = 0.034) and readmissions (0% vs 8.1%, P = 0.038). Quality-of-life was also significantly better in the ERAS group (184 ± 12.4 vs 177 ± 14.5, P = 0.022). The total medical cost was lower in the ERAS group, but not significantly ($25,445 ± 5065 vs $28,384 ± 9999, P = 0.085). CONCLUSIONS: The optimization of ERAS protocols in patients undergoing PD is safe and accelerates perioperative recovery and quality-of-life, thereby reducing the length of stay. Morbidity was significantly decreased in the ERAS group without compromising surgical outcome. REGISTRATION NUMBER: UMIN000014068.
RCT Entities:
BACKGROUND & AIMS: Evidence of the advantages of enhanced recovery after surgery (ERAS) protocols following pancreaticoduodenectomy (PD) is limited. The aim of this study was to examine the efficiency of ERAS protocols in patients following PD. METHODS: Between June 2014 and October 2016, patients undergoing PD were randomly assigned to receive ERAS protocols or standard care. The primary endpoint was the postoperative length of stay. Secondary endpoints included postoperative complications, postoperative quality-of-life (QoR-40J), readmission, and medical cost. RESULTS: Of 80 eligible patients, 74 were analyzed in intention-to-treat principles: 37 in the control group and 37 in the ERAS group. The mean length of stay in the ERAS group was significantly shorter than that in the control group (20.1 ± 5.4 vs 26.9 ± 13.5 days, P < 0.001). The ERAS group had a significantly lower percentage of postoperative complications (32.4% vs 56.8%, P = 0.034) and readmissions (0% vs 8.1%, P = 0.038). Quality-of-life was also significantly better in the ERAS group (184 ± 12.4 vs 177 ± 14.5, P = 0.022). The total medical cost was lower in the ERAS group, but not significantly ($25,445 ± 5065 vs $28,384 ± 9999, P = 0.085). CONCLUSIONS: The optimization of ERAS protocols in patients undergoing PD is safe and accelerates perioperative recovery and quality-of-life, thereby reducing the length of stay. Morbidity was significantly decreased in the ERAS group without compromising surgical outcome. REGISTRATION NUMBER: UMIN000014068.
Authors: Yang Cao; Hui-Yun Gu; Zhen-Dong Huang; Ya-Peng Wu; Qiong Zhang; Jie Luo; Chao Zhang; Yan Fu Journal: Front Oncol Date: 2019-07-30 Impact factor: 6.244
Authors: Michał Pędziwiatr; Judene Mavrikis; Jan Witowski; Alexandros Adamos; Piotr Major; Michał Nowakowski; Andrzej Budzyński Journal: Med Oncol Date: 2018-05-09 Impact factor: 3.064