Application of enhanced recovery after surgery in pancreatic surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

TIAN Fengyu , KONG Rui ,  SUN Bei

Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, P. R. China;

Corresponding author：

SUN Bei, Email: sunbei70@tom.com

Keywords：

enhanced recovery after surgery; pancreatic surgery; review

DOI：

10.7507/1007-9424.201710017

Video：

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Objective To explore the application of enhanced recovery after surgery in pancreatic surgery. Methods In this paper, the clinical research of ERAS in the field of pancreatic surgery in recent years were reviewed. Results Under the guidance of ERAS, preoperative patient education, compliance audit, and high quality preoperative preparation; minimally invasive surgery and precise fluid management; pain management, nutrition support, blood glucose regulation, and peritoneal drainage management, could be beneficial for patients to recover rapidly, shorten the hospitalization time, and reduce the hospitalization cost. Conclusions Although the application of ERAS in pancreatic surgery has been gradually accepted by the pancreas surgeon, but it still need to ensure its safety and effectiveness in the high volume pancreatic surgery center with multidisciplinary treatment. In addition, some of the recommendations in foreign guidelines are mostly cited from other disciplines of practical experience, its guiding value in pancreatic surgery is still unclear, and still needs more multicenter clinical research.

Citation： TIAN Fengyu, KONG Rui, SUN Bei. Application of enhanced recovery after surgery in pancreatic surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(4): 493-498. doi: 10.7507/1007-9424.201710017 Copy

1.	Coolsen MM, van Dam RM, Chigharoe A, et al. Improving outcome after pancreaticoduodenectomy: experiences with implementing an enhanced recovery after surgery (ERAS) program. Dig Surg, 2014, 31(3): 177-184.
2.	Morgan KA, Lancaster WP, Walters ML, et al. Enhanced recovery after surgery protocols are valuable in pancreas surgery patients. J Am Coll Surg, 2016, 222(4): 658-664.
3.	Partelli S, Crippa S, Castagnani R, et al. Evaluation of an enhanced recovery protocol after pancreaticoduodenectomy in elderly patients. HPB (Oxford), 2016, 18(2): 153-158.
4.	李民, 王新波, 王思珍, 等. 加速康复外科理念用于胰十二指肠切除术临床研究. 中国实用外科杂志, 2015, 35(8): 863-866.
5.	Eller MB, Drummond J, Pate K, et al. The impact of patient focused pre-operative education on hospital length of stay (LOS) and patient preparedness in patients undergoing pancreaticoduodenectomy (PD). Clinical Nutrition ESPEN, 2017, 19: 80.
6.	Cochran A, Tezber K, Addor V, et al. Impact of ERAS interactive audit system on compliance and outcomes after one year of ERAS implementation. Clinical Nutrition ESPEN, 2017, 19: 73-74.
7.	Lassen K, Coolsen MM, Slim K, et al. Guidelines for perioperative care for pancreaticoduodenectomy: enhanced recovery after surgery (ERAS^®) society recommendations. Clin Nutr, 2012, 31(6): 817-830.
8.	中国研究型医院学会肝胆胰外科专业委员会. 肝胆胰外科术后加速康复专家共识 (2015 版). 中华消化外科杂志, 2016, 15(1): 1-6.
9.	Bozzetti F, Mariani L. Perioperative nutritional support of patients undergoing pancreatic surgery in the age of ERAS. Nutrition, 2014, 30(11-12): 1267-1271.
10.	Holte K, Nielsen KG, Madsen JL, et al. Physiologic effects of bowel preparation. Dis Colon Rectum, 2004, 47(8): 1397-1402.
11.	Smith I, Kranke P, Murat I, et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol, 2011, 28(8): 556-569.
12.	Kiran RP, Murray AC, Chiuzan C, et al. Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery. Ann Surg, 2015, 262(3): 416-425.
13.	Branch-Elliman W, Ripollone JE, O'Brien WJ, et al. Risk of surgical site infection, acute kidney injury, and Clostridium difficile infection following antibiotic prophylaxis with vancomycin plus a beta-lactam versus either drug alone: a national propensity-score-adjusted retrospective cohort study. PLoS Med, 2017, 14(7): e1002340.
14.	Haines TP, Hill AM, Hill KD, et al. Patient education to prevent falls among older hospital inpatients: a randomized controlled trial. Arch Intern Med, 2011, 171(6): 516-524.
15.	Clarke HD, Timm VL, Goldberg BR, et al. Preoperative patient education reduces in-hospital falls after total knee arthroplasty. Clin Orthop Relat Res, 2012, 470(1): 244-249.
16.	ERAS Compliance Group. The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg, 2015, 261(6): 1153-1159.
17.	Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc, 1994, 8(5): 408-410.
18.	Røsok BI, de Rooij T, van Hilst J, et al. Minimally invasive distal pancreatectomy. HPB (Oxford), 2017, 19(3): 205-214.
19.	Magge D, Gooding W, Choudry H, et al. Comparative effectiveness of minimally invasive and open distal pancreatectomy for ductal adenocarcinoma. JAMA Surg, 2013, 148(6): 525-531.
20.	Tran Cao HS, Lopez N, Chang DC, et al. Improved perioperative outcomes with minimally invasive distal pancreatectomy: results from a population-based analysis. JAMA Surg, 2014, 149(3): 237-243.
21.	Venkat R, Edil BH, Schulick RD, et al. Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg, 2012, 255(6): 1048-1059.
22.	van Hilst J, de Rooij T, Klompmaker S, et al. Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA): a pan-european propensity score matched study. Ann Surg, 2017, [Epub ahead of print].
23.	Nassour I, Wang SC, Christie A, et al. Minimally invasive versus open pancreaticoduodenectomy: a propensity-matched study from a national cohort of patients. Ann Surg, 2017, [Epub ahead of print].
24.	Adam MA, Choudhury K, Dinan MA, et al. Minimally invasive versus open pancreaticoduodenectomy for cancer: practice patterns and short-term outcomes among 7 061 patients. Ann Surg, 2015, 262(2): 372-377.
25.	Croome KP, Farnell MB, Que FG, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg, 2014, 260(4): 633-638.
26.	Zureikat AH, Moser AJ, Boone BA, et al. 250 robotic pancreatic resections: safety and feasibility. Ann Surg, 2013, 258(4): 554-559.
27.	Adam MA, Thomas S, Youngwirth L, et al. Defining a hospital volume threshold for minimally invasive pancreaticoduodenectomy in the United States. JAMA Surg, 2017, 152(4): 336-342.
28.	NICE. Inadvertent perioperative hypothermia. 2017-03-29. https://pathways.nice.org.uk/pathways/inadvertent-perioperative-hypothermia.
29.	Rajagopalan S, Mascha E, Na J, et al. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology, 2008, 108(1): 71-77.
30.	Sessler DI. Perioperative thermoregulation and heat balance. Lancet, 2016, 387(10038): 2655-2664.
31.	Van Buren G 2^nd, Bloomston M, Hughes SJ, et al. A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann Surg, 2014, 259(4): 605-612.
32.	Van Buren G 2nd, Bloomston M, Schmidt CR, et al. A prospective randomized multicenter trial of distal pancreatectomy with and without routine intraperitoneal drainage. Ann Surg, 2017, 266(3): 421-431.
33.	Sastry A, Meyer L, Cochran A, et al. The impact of goal directed intraoperative fluid administration during pancreaticoduodenectomy on pancreatic leaks and delayed gastric emptying. Clinical Nutrition ESPEN, 2017, 19: 76.
34.	Manning MW, Dunkman WJ, Miller TE. Perioperative fluid and hemodynamic management within an enhanced recovery pathway. J Surg Oncol, 2017, 116(5): 592-600.
35.	Hübner M, Blanc C, Roulin D, et al. Randomized clinical trial on epidural versus patient-controlled analgesia for laparoscopic colorectal surgery within an enhanced recovery pathway. Ann Surg, 2015, 261(4): 648-653.
36.	Revie EJ, McKeown DW, Wilson JA, et al. Randomized clinical trial of local infiltration plus patient-controlled opiate analgesia vs. epidural analgesia following liver resection surgery. HPB (Oxford), 2012, 14(9): 611-618.
37.	van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med, 2001, 345(19): 1359-1367.
38.	NICE-SUGAR Study Investigators, Finfer S, Chittock DR, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med, 2009, 360(13): 1283-1297.
39.	Gerritsen A, Wennink RA, Besselink MG, et al. Early oral feeding after pancreatoduodenectomy enhances recovery without increasing morbidity. HPB (Oxford), 2014, 16(7): 656-664.
40.	Perinel J, Mariette C, Dousset B, et al. Early enteral versus total parenteral nutrition in patients undergoing pancreaticoduodenectomy: a randomized multicenter controlled trial (Nutri-DPC). Ann Surg, 2016, 264(5): 731-737.
41.	Bassi C, Molinari E, Malleo G, et al. Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg, 2010, 252(2): 207-214.
42.	中华医学会外科学分会胰腺外科学组, 中国研究型医院学会胰腺病专业委员会, 中华外科杂志编辑部. 胰腺术后外科常见并发症诊治及预防的专家共识 (2017). 中华外科杂志, 2017, 55(5): 328-334.
43.	Ecker BL, McMillan MT, Asbun HJ, et al. Characterization and optimal management of high-risk pancreatic anastomoses during pancreatoduodenectomy. Ann Surg, 2017, [Epub ahead of print].
44.	Kunstman JW, Klemen ND, Fonseca AL, et al. Nasogastric drainage may be unnecessary after pancreaticoduodenectomy: a comparison of routine vs selective decompression. J Am Coll Surg, 2013, 217(3): 481-488.
45.	Park JS, Kim JY, Kim JK, et al. Should gastric decompression be a routine procedure in patients who undergo pylorus-preserving pancreatoduodenectomy? World J Surg, 2016, 40(11): 2766-2770.
46.	Worsh CE, Tatarian T, Singh A, et al. Total parenteral nutrition in patients following pancreaticoduodenectomy: lessons from 1184 patients. J Surg Res, 2017, 218: 156-161.
47.	苗毅. 可能性与可行性: 加速康复外科在胰腺外科的开展及应用. 中华外科杂志, 2016, 5(11): 804-806.
48.	刘展, 汪晓东, 李立. 多学科协作诊治模式下的结直肠外科快速康复流程. 中国普外基础与临床杂志, 2007, 14(2): 239-242.

1. Coolsen MM, van Dam RM, Chigharoe A, et al. Improving outcome after pancreaticoduodenectomy: experiences with implementing an enhanced recovery after surgery (ERAS) program. Dig Surg, 2014, 31(3): 177-184.
2. Morgan KA, Lancaster WP, Walters ML, et al. Enhanced recovery after surgery protocols are valuable in pancreas surgery patients. J Am Coll Surg, 2016, 222(4): 658-664.
3. Partelli S, Crippa S, Castagnani R, et al. Evaluation of an enhanced recovery protocol after pancreaticoduodenectomy in elderly patients. HPB (Oxford), 2016, 18(2): 153-158.
4. 李民, 王新波, 王思珍, 等. 加速康复外科理念用于胰十二指肠切除术临床研究. 中国实用外科杂志, 2015, 35(8): 863-866.
5. Eller MB, Drummond J, Pate K, et al. The impact of patient focused pre-operative education on hospital length of stay (LOS) and patient preparedness in patients undergoing pancreaticoduodenectomy (PD). Clinical Nutrition ESPEN, 2017, 19: 80.
6. Cochran A, Tezber K, Addor V, et al. Impact of ERAS interactive audit system on compliance and outcomes after one year of ERAS implementation. Clinical Nutrition ESPEN, 2017, 19: 73-74.
7. Lassen K, Coolsen MM, Slim K, et al. Guidelines for perioperative care for pancreaticoduodenectomy: enhanced recovery after surgery (ERAS^®) society recommendations. Clin Nutr, 2012, 31(6): 817-830.
8. 中国研究型医院学会肝胆胰外科专业委员会. 肝胆胰外科术后加速康复专家共识 (2015 版). 中华消化外科杂志, 2016, 15(1): 1-6.
9. Bozzetti F, Mariani L. Perioperative nutritional support of patients undergoing pancreatic surgery in the age of ERAS. Nutrition, 2014, 30(11-12): 1267-1271.
10. Holte K, Nielsen KG, Madsen JL, et al. Physiologic effects of bowel preparation. Dis Colon Rectum, 2004, 47(8): 1397-1402.
11. Smith I, Kranke P, Murat I, et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol, 2011, 28(8): 556-569.
12. Kiran RP, Murray AC, Chiuzan C, et al. Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery. Ann Surg, 2015, 262(3): 416-425.
13. Branch-Elliman W, Ripollone JE, O'Brien WJ, et al. Risk of surgical site infection, acute kidney injury, and Clostridium difficile infection following antibiotic prophylaxis with vancomycin plus a beta-lactam versus either drug alone: a national propensity-score-adjusted retrospective cohort study. PLoS Med, 2017, 14(7): e1002340.
14. Haines TP, Hill AM, Hill KD, et al. Patient education to prevent falls among older hospital inpatients: a randomized controlled trial. Arch Intern Med, 2011, 171(6): 516-524.
15. Clarke HD, Timm VL, Goldberg BR, et al. Preoperative patient education reduces in-hospital falls after total knee arthroplasty. Clin Orthop Relat Res, 2012, 470(1): 244-249.
16. ERAS Compliance Group. The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg, 2015, 261(6): 1153-1159.
17. Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc, 1994, 8(5): 408-410.
18. Røsok BI, de Rooij T, van Hilst J, et al. Minimally invasive distal pancreatectomy. HPB (Oxford), 2017, 19(3): 205-214.
19. Magge D, Gooding W, Choudry H, et al. Comparative effectiveness of minimally invasive and open distal pancreatectomy for ductal adenocarcinoma. JAMA Surg, 2013, 148(6): 525-531.
20. Tran Cao HS, Lopez N, Chang DC, et al. Improved perioperative outcomes with minimally invasive distal pancreatectomy: results from a population-based analysis. JAMA Surg, 2014, 149(3): 237-243.
21. Venkat R, Edil BH, Schulick RD, et al. Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg, 2012, 255(6): 1048-1059.
22. van Hilst J, de Rooij T, Klompmaker S, et al. Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA): a pan-european propensity score matched study. Ann Surg, 2017, [Epub ahead of print].
23. Nassour I, Wang SC, Christie A, et al. Minimally invasive versus open pancreaticoduodenectomy: a propensity-matched study from a national cohort of patients. Ann Surg, 2017, [Epub ahead of print].
24. Adam MA, Choudhury K, Dinan MA, et al. Minimally invasive versus open pancreaticoduodenectomy for cancer: practice patterns and short-term outcomes among 7 061 patients. Ann Surg, 2015, 262(2): 372-377.
25. Croome KP, Farnell MB, Que FG, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg, 2014, 260(4): 633-638.
26. Zureikat AH, Moser AJ, Boone BA, et al. 250 robotic pancreatic resections: safety and feasibility. Ann Surg, 2013, 258(4): 554-559.
27. Adam MA, Thomas S, Youngwirth L, et al. Defining a hospital volume threshold for minimally invasive pancreaticoduodenectomy in the United States. JAMA Surg, 2017, 152(4): 336-342.
28. NICE. Inadvertent perioperative hypothermia. 2017-03-29. https://pathways.nice.org.uk/pathways/inadvertent-perioperative-hypothermia.
29. Rajagopalan S, Mascha E, Na J, et al. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology, 2008, 108(1): 71-77.
30. Sessler DI. Perioperative thermoregulation and heat balance. Lancet, 2016, 387(10038): 2655-2664.
31. Van Buren G 2^nd, Bloomston M, Hughes SJ, et al. A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann Surg, 2014, 259(4): 605-612.
32. Van Buren G 2nd, Bloomston M, Schmidt CR, et al. A prospective randomized multicenter trial of distal pancreatectomy with and without routine intraperitoneal drainage. Ann Surg, 2017, 266(3): 421-431.
33. Sastry A, Meyer L, Cochran A, et al. The impact of goal directed intraoperative fluid administration during pancreaticoduodenectomy on pancreatic leaks and delayed gastric emptying. Clinical Nutrition ESPEN, 2017, 19: 76.
34. Manning MW, Dunkman WJ, Miller TE. Perioperative fluid and hemodynamic management within an enhanced recovery pathway. J Surg Oncol, 2017, 116(5): 592-600.
35. Hübner M, Blanc C, Roulin D, et al. Randomized clinical trial on epidural versus patient-controlled analgesia for laparoscopic colorectal surgery within an enhanced recovery pathway. Ann Surg, 2015, 261(4): 648-653.
36. Revie EJ, McKeown DW, Wilson JA, et al. Randomized clinical trial of local infiltration plus patient-controlled opiate analgesia vs. epidural analgesia following liver resection surgery. HPB (Oxford), 2012, 14(9): 611-618.
37. van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med, 2001, 345(19): 1359-1367.
38. NICE-SUGAR Study Investigators, Finfer S, Chittock DR, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med, 2009, 360(13): 1283-1297.
39. Gerritsen A, Wennink RA, Besselink MG, et al. Early oral feeding after pancreatoduodenectomy enhances recovery without increasing morbidity. HPB (Oxford), 2014, 16(7): 656-664.
40. Perinel J, Mariette C, Dousset B, et al. Early enteral versus total parenteral nutrition in patients undergoing pancreaticoduodenectomy: a randomized multicenter controlled trial (Nutri-DPC). Ann Surg, 2016, 264(5): 731-737.
41. Bassi C, Molinari E, Malleo G, et al. Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg, 2010, 252(2): 207-214.
42. 中华医学会外科学分会胰腺外科学组, 中国研究型医院学会胰腺病专业委员会, 中华外科杂志编辑部. 胰腺术后外科常见并发症诊治及预防的专家共识 (2017). 中华外科杂志, 2017, 55(5): 328-334.
43. Ecker BL, McMillan MT, Asbun HJ, et al. Characterization and optimal management of high-risk pancreatic anastomoses during pancreatoduodenectomy. Ann Surg, 2017, [Epub ahead of print].
44. Kunstman JW, Klemen ND, Fonseca AL, et al. Nasogastric drainage may be unnecessary after pancreaticoduodenectomy: a comparison of routine vs selective decompression. J Am Coll Surg, 2013, 217(3): 481-488.
45. Park JS, Kim JY, Kim JK, et al. Should gastric decompression be a routine procedure in patients who undergo pylorus-preserving pancreatoduodenectomy? World J Surg, 2016, 40(11): 2766-2770.
46. Worsh CE, Tatarian T, Singh A, et al. Total parenteral nutrition in patients following pancreaticoduodenectomy: lessons from 1184 patients. J Surg Res, 2017, 218: 156-161.
47. 苗毅. 可能性与可行性: 加速康复外科在胰腺外科的开展及应用. 中华外科杂志, 2016, 5(11): 804-806.
48. 刘展, 汪晓东, 李立. 多学科协作诊治模式下的结直肠外科快速康复流程. 中国普外基础与临床杂志, 2007, 14(2): 239-242.

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Application of enhanced recovery after surgery in pancreatic surgery

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