title: Perioperative management in distal pancreatectomy: results of a survey in 23 European participating centres of the DISPACT trial and a review of literature.
abstract: BACKGROUND
  Concomitant treatment in addition to intervention may influence the primary outcome, especially in complex interventions such as surgical trials. Evidence-based standards for perioperative care after distal pancreatectomy, however, have been rarely defined. This study's objective was therefore to identify and analyse the current basis of evidence for perioperative management in distal pancreatectomy.
  
  
  METHODS
  A standardised questionnaire was sent to 23 European centres recruiting patients for a randomized controlled trial (RCT) on open distal pancreatectomy that would compare suture versus stapler closure of the pancreatic remnant (DISPACT trial, ISRCTN 18452029). Perioperative strategies (e.g., bowel preparation, pain management, administration of antibiotics, abdominal incision, drainages, nasogastric tubes, somatostatin, mobilisation and feeding regimens) were assessed. Moreover, a systematic literature search in the Medline database was performed and retrieved meta-analyses and RCTs were reviewed.
  
  
  RESULTS
  All 23 centres returned the questionnaire. Consensus for thoracic epidural catheters (TECs), pain treatment and transverse incisions was found, as well as strong consensus for the placement of intra-abdominal drainages and perioperative single-shot antibiotics. Also, there was consensus that bowel preparation, somatostatin application, postoperative nasogastric tubes and intravenous feeding might not be beneficial. The literature search identified 16 meta-analyses and 19 RCTs demonstrating that bowel preparation, somatostatin therapy and nasogastric tubes can be omitted. Early mobilisation, feeding and TECs seem to be beneficial for patients. The value of drainages remains unclear.
  
  
  CONCLUSIONS
  Most perioperative standards within the centres participating in the DISPACT trial are in accordance with current available evidence. The need for drainages requires further investigation.
  
  
  BACKGROUND
  
  
  
  BACKGROUND
  ISRCTN 18452029.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany. helge.bruns@med.uni-heidelberg.de
authors.forename: Helge
authors.initials: H
authors.lastname: Bruns
authors.forename: Nuh N
authors.initials: NN
authors.lastname: Rahbari
authors.forename: Thorsten
authors.initials: T
authors.lastname: Löffler
authors.forename: Markus K
authors.initials: MK
authors.lastname: Diener
authors.forename: Christoph M
authors.initials: CM
authors.lastname: Seiler
authors.forename: Matthias
authors.initials: M
authors.lastname: Glanemann
authors.forename: Giovanni
authors.initials: G
authors.lastname: Butturini
authors.forename: Christoph
authors.initials: C
authors.lastname: Schuhmacher
authors.forename: Inga
authors.initials: I
authors.lastname: Rossion
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Tido
authors.initials: T
authors.lastname: Junghans
mesh_terms: D019985:Benchmarking; D005060:Europe; D019538:Health Care Surveys; D006801:Humans; D010180:Pancreatectomy / Q000379:methods* / Q000592:standards; D010182:Pancreatic Diseases / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods* / Q000592:standards; D011795:Surveys and Questionnaires