The Safety and Feasibility of Enhanced Recovery after Surgery in Patients Undergoing Pancreaticoduodenectomy: An Updated Meta-Analysis

Abstract

Background. Enhanced recovery after surgery (ERAS) is a multimodal, multidisciplinary, evidence-based approach to care for surgical patients and aims at optimizing the perioperative management and outcomes. The ERAS approach was first implemented in colorectal surgery patients; however, the reported applications in pancreatoduodenectomy patients are limited. In recent years, studies on ERAS for patients undergoing pancreaticoduodenectomy have been published. The accumulation of new randomized controlled trials and high-quality case-control studies stimulated us to update the analysis. Our study comprehensively collected data to provide the best evidence summary for the clinic. Aim. To evaluate the safety and feasibility of enhanced recovery after surgery in the perioperative management of pancreatoduodenectomy patients. Methods. A systematic literature search of PubMed, Embase, and the Cochrane Library was performed up to July 2019. All randomized controlled trials and case-control studies that applied ERAS for patients undergoing pancreaticoduodenectomy were considered for inclusion in this study. The patients were divided into two groups: patients who received the ERAS perioperative management approach were defined as the ERAS group and patients who received the traditional perioperative management approach were defined as the control group. All statistical analyses were conducted using the Revman5.3 software, and the outcomes were calculated as odds ratios or weighted mean differences with their corresponding 95% confidence intervals. A funnel plot was created to assess publication bias. Subgroup and sensitivity analyses were performed to explore the sources of heterogeneity. Results. A total of 20 studies involving 3613 patients (1914 patients in the ERAS group vs. 1699 patients in the control group) were included in this study. Among the 20 studies, 4 were randomized controlled trials, and 16 were case-control studies. The overall postoperative complication rate was significantly lower in the ERAS group (OR=0.62, 95% CI: 0.53-0.74, P<0.00001) than in the control group. In addition, the minor complication rate (Clavien-Dindo I-II) was also lower in the ERAS group (OR=0.70, 95% CI: 0.58-0.86, P=0.0005). The patients in the ERAS group had a lower incidence of delayed gastric emptying (OR=0.51, 95% CI: 0.42-0.63, P<0.00001) and shorter length of hospital stay (WMD=−4.27, 95% CI: -4.81~-3.73, P<0.00001) than in the control group. The rates of pancreatic fistula (regardless of Grade A/B/C), wound infections, abdominal abscesses, readmission, reoperation, and morbidity were not significantly different between the two groups. Conclusion. The ERAS approach is safe and effective in the perioperative management of patients undergoing pancreaticoduodenectomy and helps to accelerate the postoperative recovery and improve prognosis.

The Clinical Efficacy and Safety of Enhanced Recovery After Surgery for Cesarean Section: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies

“…Enhanced recovery after surgery (ERAS) is a multimodal and multidisciplinary approach to optimizing the perioperative management and outcomes ( 9 ). The core tenets of the ERAS have been outlined previously and are positioned along the entire surgical care continuum, aiming to alleviate the surgical stress response, promote functional recovery, and achieve rapid recovery ( 10 , 11 ). ERAS has been widely implemented in multiple surgical disciplines including colorectal, urologic, hepatobiliary, and gynecologic surgery ( 12 , 13 ).…”

Optimierung der perioperativen Behandlung durch Fast-Track und ERAS

“…In den RCTs war die Komplikationsrate nicht mit der Art der perioperativen Behandlung assoziiert (53,1% vs. 63,1%) 13 . Pankreasfisteln, Reinterventionen bzw.…”

Achieving ‘Marginal Gains’ to Optimise Outcomes in Resectable Pancreatic Cancer

“…ERAS after pancreatic surgery have been associated with a reduction in mild complications (Clavien Dindo grade I-II) significant improvements in overall morbidity and length of stay without any increase in readmission [ 121 , 122 , 123 , 124 , 125 ]. Effect on pancreatic specific complications is difficult to interpret as studies have variably included PD and distal pancreatectomy and ISGPS definitions have not been consistently reported for delayed gastric emptying (DGE) and postoperative pancreatic fistula (POPF) However, a lower incidence of DGE has been observed with no effect on POPF rate [ 122 , 123 , 125 ].…”