Emmanuel Melloul1, Kristoffer Lassen2, Didier Roulin1, Fabian Grass1, Julie Perinel3, Mustapha Adham3, Erik Björn Wellge4, Filipe Kunzler5, Marc G Besselink6, Horacio Asbun5, Michael J Scott7, Cornelis H C Dejong8, Dionisos Vrochides9, Thomas Aloia10, Jakob R Izbicki4, Nicolas Demartines11. 1. Department of Visceral Surgery, University Hospital Lausanne (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland. 2. Department of Hepatobiliary and Pancreatic Surgery, Oslo University Hospital, Oslo, Norway. 3. Service de chirurgie Digestive, Hôpital Edouard Herriot, Hospices Civils De Lyon, Lyon, France. 4. Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, 20246, Hamburg, Germany. 5. Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA. 6. Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 7. Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK. 8. Departments of Surgery, Maastricht University, Maastricht, The Netherlands. 9. Division of Hepatopancreatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA. 10. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 11. Department of Visceral Surgery, University Hospital Lausanne (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland. Demartines@chuv.ch.
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.
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.
Authors: Alice Avancini; Ilaria Trestini; Daniela Tregnago; Lorenzo Belluomini; Marco Sposito; Jessica Insolda; Federico Schena; Michele Milella; Sara Pilotto Journal: J Cancer Res Clin Oncol Date: 2022-08-09 Impact factor: 4.322
Authors: Rony Takchi; Heidy Cos; Gregory A Williams; Cheryl Woolsey; Chet W Hammill; Ryan C Fields; Steven M Strasberg; William G Hawkins; Dominic E Sanford Journal: HPB (Oxford) Date: 2021-06-16 Impact factor: 3.842