Christoph Kuemmerli1,2,3, Christoph Tschuor1,4,5, Meidai Kasai6, Adnan A Alseidi7, Gianpaolo Balzano8, Stefan Bouwense9, Marco Braga10, Mariëlle Coolsen9, Sara K Daniel11, Christos Dervenis12, Massimo Falconi8, Dae Wook Hwang13, Daniel J Kagedan14, Song Cheol Kim13, Harish Lavu15, Tingbo Liang16, Daniel Nussbaum17, Stefano Partelli8, Michael J Passeri4, Nicolò Pecorelli8, Sastha Ahanatha Pillai18, Venu G Pillarisetty11, Michael J Pucci15, Wei Su16, Robert P Sutcliffe19, Bobby Tingstedt20, Marion van der Kolk21, Dionisios Vrochides4, Alice Wei22, Caroline Williamsson20, Charles J Yeo15, Sabino Zani17, Efstratios Zouros12, Mohammed Abu Hilal1,2. 1. Department of Surgery, Foundation Poliambulanza, Brescia, Italy. 2. Department of Surgery, Hepatobiliary and Pancreatic Surgical Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK. 3. Department of Surgery, Clarunis-University Centre for Gastrointestinal and Liver Diseases Basle, Basle, Switzerland. 4. Division of Hepatopancreatobiliary Surgery, Department of Surgery, Carolinas Medical Centre, Charlotte, North Carolina, USA. 5. Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. 6. Department of Surgery, Meiwa Hospital, Hyogo, Japan. 7. Department of Surgery, University of California San Francisco, San Francisco, California, USA. 8. Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Milan, Italy. 9. Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands. 10. Department of Surgery, Monza Hospital, University of Milano Bicocca, Monza, Italy. 11. Hepatopancreatobiliary Surgery, University of Washington, Seattle, Washington, USA. 12. Department of Surgery, Konstantopouleio General Hospital, Nea Ionia, Athens, Greece. 13. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea. 14. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. 15. Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. 16. Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, Zhejiang, China. 17. Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA. 18. Department of Surgery, Institute of Surgical Gastroenterology and Liver Transplantation, Government Stanley Medical College, Chennai, India. 19. Department of Hepatobiliary and Pancreatic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. 20. Department of Surgery, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden. 21. Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands. 22. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Abstract
BACKGROUND: This individual-patient data meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared with conventional care on postoperative outcomes in patients undergoing pancreatoduodenectomy. METHODS: The Cochrane Library, MEDLINE, Embase, Scopus, and Web of Science were searched systematically for articles reporting outcomes of ERAS after pancreatoduodenectomy published up to August 2020. Comparative studies were included. Main outcomes were postoperative functional recovery elements, postoperative morbidity, duration of hospital stay, and readmission. RESULTS: Individual-patient data were obtained from 17 of 31 eligible studies comprising 3108 patients. Time to liquid (mean difference (MD) -3.23 (95 per cent c.i. -4.62 to -1.85) days; P < 0.001) and solid (-3.84 (-5.09 to -2.60) days; P < 0.001) intake, time to passage of first stool (MD -1.38 (-1.82 to -0.94) days; P < 0.001) and time to removal of the nasogastric tube (3.03 (-4.87 to -1.18) days; P = 0.001) were reduced with ERAS. ERAS was associated with lower overall morbidity (risk difference (RD) -0.04, 95 per cent c.i. -0.08 to -0.01; P = 0.015), less delayed gastric emptying (RD -0.11, -0.22 to -0.01; P = 0.039) and a shorter duration of hospital stay (MD -2.33 (-2.98 to -1.69) days; P < 0.001) without a higher readmission rate. CONCLUSION: ERAS improved postoperative outcome after pancreatoduodenectomy. Implementation should be encouraged.
BACKGROUND: This individual-patient data meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared with conventional care on postoperative outcomes in patients undergoing pancreatoduodenectomy. METHODS: The Cochrane Library, MEDLINE, Embase, Scopus, and Web of Science were searched systematically for articles reporting outcomes of ERAS after pancreatoduodenectomy published up to August 2020. Comparative studies were included. Main outcomes were postoperative functional recovery elements, postoperative morbidity, duration of hospital stay, and readmission. RESULTS: Individual-patient data were obtained from 17 of 31 eligible studies comprising 3108 patients. Time to liquid (mean difference (MD) -3.23 (95 per cent c.i. -4.62 to -1.85) days; P < 0.001) and solid (-3.84 (-5.09 to -2.60) days; P < 0.001) intake, time to passage of first stool (MD -1.38 (-1.82 to -0.94) days; P < 0.001) and time to removal of the nasogastric tube (3.03 (-4.87 to -1.18) days; P = 0.001) were reduced with ERAS. ERAS was associated with lower overall morbidity (risk difference (RD) -0.04, 95 per cent c.i. -0.08 to -0.01; P = 0.015), less delayed gastric emptying (RD -0.11, -0.22 to -0.01; P = 0.039) and a shorter duration of hospital stay (MD -2.33 (-2.98 to -1.69) days; P < 0.001) without a higher readmission rate. CONCLUSION: ERAS improved postoperative outcome after pancreatoduodenectomy. Implementation should be encouraged.