Intensive perioperative rehabilitation improves surgical outcomes after pancreaticoduodenectomy

Kitahata, Yuji; Hirono, Seiko; Kawai, Manabu; Okada, Ken-ichi; Miyazawa, Motoki; Shimizu, Atsushi; Kobayashi, Ryouhei; Ueno, Masaki; Hayami, Shinya; Shimokawa, Toshio; Kouda, Ken; Tajima, Fumihiro; Yamaue, Hiroki

doi:10.1007/s00423-018-1710-1

Cited by 40 publications

(50 citation statements)

References 41 publications

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“…A systematic review on prehabilitation in major abdominal surgery showed an overall reduction in postoperative complication rates with a greater effect of multimodal prehabilitation programs (26). Although prehabilitation has been shown to result in a significant reduction of pulmonary complications and length of hospital stay in patients undergoing a pancreatoduodenectomy, the benefit in improved clinical outcomes for esophagectomy patients has not yet been demonstrated (25,27,28).…”

Section: Improvement In Perioperative Carementioning

confidence: 99%

Effects of improving outcomes after esophagectomy on the short- and long-term: a review of literature

Fransen

Luyer

2019

J. Thorac. Dis

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An esophagectomy is still correlated with a high morbidity rate, despite advances made in minimally invasive surgery, enhanced recovery after surgery (ERAS) and centralization of this type of surgery. The short-term benefits are clearly described for esophageal cancer surgery patients, however, the longterm effects are yet to be determined. In colorectal cancer, the association between complications, especially anastomotic leakage, shows detrimental effects on long-term survival and cancer recurrence. In esophageal cancer surgery, current evidence is scarce and the described results are conflicting. Optimization of perioperative care by introduction of minimally invasive surgery, ERAS programs and patient prehabilitation is promising and shows a clear effect on short-term outcomes. Potentially, this may also result in better outcomes on the long-term, although current evidence is insufficient to infer definite conclusions. Reduction of anastomotic leakage seems important to reduce risk of cancer recurrence and improve long-term outcome.

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Section: Improvement In Perioperative Carementioning

confidence: 99%

Effects of improving outcomes after esophagectomy on the short- and long-term: a review of literature

Fransen

Luyer

2019

J. Thorac. Dis

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“…Guidelines for ERAS protocol are based on these studies and applied in many hospitals worldwide [ 12 – 14 ]. Achieving the same goals, recent studies have shown the benefits of introducing other similar pathways, especially targeting perioperative rehabilitation and more precisely pre-habilitation [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of ERAS compliance on the delay between surgery and adjuvant chemotherapy in hepatobiliary and pancreatic malignancies

St-Amour

St‐Amour

Joliat

et al. 2020

Langenbecks Arch Surg

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Background Multidisciplinary approach with adjuvant chemotherapy is the key element to provide optimal outcomes in pancreas and liver malignancies. However, post-operative complications may increase the interval between surgery and chemotherapy with negative oncologic effects. Hypothesis and study aim The aim of the study was to analyse whether compliance to Enhanced Recovery After Surgery (ERAS) pathway was associated with decreased interval to adjuvant chemotherapy. Methods Retrospective analysis of all consecutive ERAS patients with surgery for hepatobiliary or pancreatic malignancies at the University Hospital of Lausanne between 2012 and 2016. Multivariate analysis was performed to assess the impact of ERAS compliance on time to chemotherapy. Results A total of 133 patients with adjuvant chemotherapy were included (n = 44 liver and n = 89 pancreatic cancer). Median compliance to ERAS was 61% (IQR 55–67) for the study population, and median delay to chemotherapy was 49 days (IQR 39-61). Overall, compliance ≥ 67% to ERAS induced a significant reduction in the interval between surgery and chemotherapy for young patients (< 65 years old) with or without severe comorbidities (reduction of 22 and 10 days, respectively). High compliance in young ASA3 patients with liver colorectal metastases was associated with an increase of 481 days of DFS. Conclusions ERAS compliance ≥ 67% tends to be associated with a reduction in the delay to adjuvant chemotherapy for young patients with hepatobiliary and pancreatic malignancies. More prospective studies with strict adhesion to the ERAS protocol are needed to confirm these results.

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“…Pancreaticoduodenectomy (PD) is one of the greatest challenges in gastrointestinal surgery, with mortality < 5% in high-volume centers, and even 50% of perioperative complications [1,2]. The anastomosis of the pancreatic stump is considered the most difficult phase of the surgery, crucial for postoperative healing.…”

Section: Introductionmentioning

confidence: 99%

Pancreaticojejunostomy—a review of modern techniques

Grudzińska

Mrowiec

2020

Langenbecks Arch Surg

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Background Pancreaticojejunal anastomosis is one of the most demanding procedures in surgery. Up to now, no technique has been proven to reduce the incidence of POPF when compared to the other methods. Purpose The aim of this review was to provide a concise and illustrated description of the most recent methods of pancreaticojejunostomy. Their development was directly related to the still ongoing search by surgeons for such a technique of anastomosis that would eliminate the problem of POPF. Conclusions Knowledge of various techniques of anastomosis may help the surgeon to find the most suitable and optimal method of pancreatic-intestinal anastomosis for the patient.

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Intensive perioperative rehabilitation improves surgical outcomes after pancreaticoduodenectomy

Cited by 40 publications

References 41 publications

Effects of improving outcomes after esophagectomy on the short- and long-term: a review of literature

Effects of improving outcomes after esophagectomy on the short- and long-term: a review of literature

Impact of ERAS compliance on the delay between surgery and adjuvant chemotherapy in hepatobiliary and pancreatic malignancies

Pancreaticojejunostomy—a review of modern techniques

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