Enhanced Recovery Pathways in Pancreatic Surgery

Barton JG. Enhanced Recovery Pathways in Pancreatic Surgery. Surg Clin North Am. 2016 Dec;96(6):1301-1312.

What is already known: Mortality in pancreatic surgery has improved dramatically over the past number of years, from 25% in the 1970’s to only 2% in high-volume centres. Morbidity however remains in excess of 40%. The ERAS society has produced guidelines for pancreatic surgery in 2012, which can be found here.

What this paper adds: This is a really good overview of ERAS for pancreatic surgery, with both a literature review and a more detailed look at some of the specific pancreatic elements. These include: pre-operative biliary drainage, use of intra-abdominal drains post-op, somatostatin analogues and different analgesic regimens. The author also gives a detailed day to day run through of his own institutional ERAS programme.

Chris Jones, Guildford.

ERAS for elderly patients undergoing pancreaticoduodenectomy

Partelli S, Crippa S, Castagnani R, Ruffo G, Marmorale C, Franconi AM, De Angelis C, Falconi M. Evaluation of an enhanced recovery protocol after pancreaticoduodenectomy in elderly patients. HPB (Oxford). 2016 Feb;18(2):153-8.

What is already known:

ERAS society guidelines exist for major pancreatic resections (link), and this study aims to study the effects of an ERAS program on elderly patients (>75 years) undergoing pancreaticoduodenectomy, compared to a historical cohort.

What this paper adds:

A retrospective study demonstrating that ERAS is feasible and safe for elderly patients undergoing pancreaticoduodenectomy. In this small study (88 patients, of which 22 patients underwent an ERAS programme and 66 were historical controls) there was no overall difference in postoperative outcomes, but found a reduced length of stay in patients who had no complications (4 versus 8 days).

Adherence to ERAS elements was mixed. Only 9% had their abdominal drains removed early and 32% tolerated starting an oral diet before postoperative day 4. Whilst 95% had epidural analgesia and 90% had early NG tube removal and tolerated early mobilisation.

Chris Jones, Guildford.