Enhanced recovery after pancreatic surgery: A prospective randomized controlled clinical trial

Abstract

Background and Objectives: The enhanced recovery after surgery (ERAS) protocol is a perioperative care bundle designed to achieve early healing after surgical procedures. This study aims to investigate the effect of the ERAS protocol on postoperative complications, length of hospital stay (LOS), and readmission rates in pancreatic surgery patients. Methods:The study was designed as a prospective and randomized controlled study between January 2016 and November 2018 on pancreatic surgery patients. A total of 38 patients were analyzed, 18 of whom were in the ERAS group and 20 in the control group. Patient demographics, intraoperative variables, and postoperative outcomes were recorded. Results:The groups were similar regarding age, sex, surgery type, American Society of Anesthesiologists scores, and laboratory results. There was no significant difference in the intraoperative variables. Early oral feeding was preferred, mostly in the ERAS group compared to the control group. Perioperative complication rates, including delayed gastric emptying and pancreatic fistula, LOS, and readmission rates, were similar between the two groups. Conclusions:The ERAS protocol provided a minimal decrease in the total complication rates and had no effect on severe complications. Therefore, the ERAS protocol seems feasible and can be applied safely in pancreatic surgery patients.

Successful Management of a Patient With a History of Postoperative Delirium Undergoing Cardiac Surgery With an Erector Spinae Plane Block and Multimodal Analgesia: A Case Report

“…Opioid-based anesthesia was previously considered the gold standard for open cardiac surgery because of better hemodynamic stability and postoperative pain control despite complications such as respiratory depression, nausea, vomiting, and hyperalgesia [ 1 ]. Cardiac enhanced recovery after surgery protocols (ERAS-C) include multimodal analgesia and regional anesthesia and are utilized to decrease opioid requirements to accelerate recovery and shorten the postoperative length of stay [ 2 ]. There is a growing consensus that using opioids for anesthesia can precipitate perioperative delirium [ 3 ].…”

Dissection Around the Superior Mesenteric Artery (SMA) Using LigaSure Maryland During Left Posterior Approach for Pancreaticoduodenectomy

“…R0 resection for pancreatic head cancer demands complete resection of "mesopancreas" [5,6], which implies dividing the proximal jejunal artery (JA) and jejunal vein (JV) at their roots of the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) respectively during pancreaticoduodenectomy (PD). PD is considered one of the most complicated abdominal surgeries with high mortality and morbidity rates [7].…”

Who could complete and benefit from the adjuvant chemotherapy regarding pancreatic ductal adenocarcinoma? A multivariate‐adjusted analysis at the pre‐adjuvant chemotherapy timing

“…Surgical trauma during pancreatic surgery is heavy, 7,8 and complications of pancreatic surgery are frequent 9–13 . Thus, the recovery periods of patients with PDAC varied significantly 7,8 . Further, the timing of chemotherapy administration differs among these patients.…”

“…3,4 However, most patients could not complete the chemotherapy courses, and many of them experienced tumor recurrence within half a year. 5,6 Surgical trauma during pancreatic surgery is heavy, 7,8 and complications of pancreatic surgery are frequent. [9][10][11][12][13] Thus, the recovery periods of patients with PDAC varied significantly.…”

“…[9][10][11][12][13] Thus, the recovery periods of patients with PDAC varied significantly. 7,8 Further, the timing of chemotherapy administration differs among these patients. Though it is ever reported that time to starting chemotherapy did not influence overall survival rates, 14 it is not studied and discussed in the East Asian population.…”