Systematic Review and Meta-analysis of Enhanced Recovery After Pancreatic Surgery with Particular Emphasis on Pancreaticoduodenectomies.

BACKGROUND: In the past decade, Enhanced Recovery after Surgery (ERAS) have been implemented in several fields of surgery. With these faster recovery and shorter hospital stay can be accomplished without an in morbidity or mortality. The purpose of this study was to review the evidence for implementation of an ERAS protocol in pancreatic with particular emphasis on pancreaticoduodenectomies (PDs). METHODS: A systematic search was performed in Medline, Embase, Pubmed, CINAHL, and Cochrane library for papers describing an ERAS program in adult patients undergoing elective pancreatic surgery published between January 1966 December 2012. The primary outcome measure was postoperative length of Secondary outcome measures were time to recovery of normal function, postoperative complication rates, readmissions, and mortality. meta-analysis of outcome measures focusing on PD was conducted. This review and meta-analysis was performed according to the PRISMA RESULTS: The literature search produced 248 potentially relevant papers. these, eight papers met the predefined inclusion criteria: five case- studies, two retrospective studies, and one prospective study, of 1,558 patients. Only three of the studies reported data on discharge and assessed time to recovery and return to normal function. ERAS protocol led in four of five comparative studies to a significant in length of stay (reduction of 2-6 days in different studies). Meta- four studies focusing on PDs showed that there was a significant complication rates in favor of the ERAS group (absolute risk difference % confidence interval (CI) 2.0-14.4, p = 0.008). Introduction of an ERAS did not result in an increase in mortality or readmissions. Delayed emptying and incidence of pancreatic fistula did not differ groups. All studies reporting on hospital costs showed a decrease after implementation of ERAS. CONCLUSIONS: This systematic review suggests an ERAS protocol in pancreatic resections may help to shorten hospital stay without compromising morbidity and mortality. This seemed to apply pancreatectomy, total pancreatectomy, and PD. Meta-analysis was those studies focusing on PD and showed that there were no differences readmission or mortality. Morbidity rates were significantly lower for managed according ERAS principles