Multimodal programme of enhanced recovery following pancreaticoduodenectomy

Abstract

Background: Mortality after pancreaticoduodenectomy (PD) decreased from 25% to 1–3% in recent decades. However, the number of early postoperative complications varies from 29.5% to 70%. Therefore, there is a need for new methods of perioperative management of patients after PD to improve the immediate results. The aim of the study was to analyze the effectiveness of different perioperative treatment regimen in patients after PD.

Materials and methods: This prospective-retrospective study included 78 patients after PD from 2003 to 2017. For comparative analysis, the patients were divided into 2 groups: group I included 39 patients recruited from January 2015 to December 2017. In them the perioperative treatment was carried out in accordance with the enhanced recovery programme, group II consisted of 39 patients recruited from January 2003 to December 2014, in whom the perioperative care was conducted traditionally. We studied the time to restoration of oral nutrition, postoperative complications, and duration of hospital stay.

Results: There were no mortality in groups. The overall incidence of Clavien – Dindo complications in group I was significantly lower than in group II (10 (25.6%) vs 18 (46.1%) corr., p=0.029). The incidence of delayed gastric emptying in group I was lower compared to group II (15.4% (6 patients) vs 35.9% (14 patients), p=0.009). The incidence of pancreatic fistula (PF) in groups I and II did not differ significantly – 10.2% (4 patients) and 12.8% (5 patients), respectively (p=0.36). The incidence of infectious complications in group I was reduced in comparison with group II (5.1% (2 patients) vs 17.9% (7 patients), p=0.031). The mean duration of hospital stay in I was significantly less compared with group II (14 days 95% CI: [13, 17] vs. 18 days 95% CI: [16, 18], p=0.012).

Conclusions. Implementation of the ERAS program in PD reduces postoperative morbidity and duration of hospital stay, demonstrating its feasibility in clinical practice.