Guidelines for Perioperative Care for Pancreatoduodenectomy

  • Emmanuel Melloul
  • Kristoffer Lassen
  • Didier Roulin
  • Fabian Grass
  • Julie Perinel
  • Mustapha Adham
  • Björn Erik Wellge
  • Filipe Kunzler
  • Marc G Besselink
  • Horacio Asbun
  • Michael J Scott
  • Cornelis H C Dejong
  • Dionisos Vrochides
  • Thomas Aloia
  • Jakob R Izbicki
  • Nicolas Demartines


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.

Bibliografische Daten

StatusVeröffentlicht - 07.2020
PubMed 32161987