Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations.
OBJECTIVE
Protocols for enhanced recovery provide comprehensive and evidence-based guidelines for best perioperative care. Protocol implementation may reduce complication rates and enhance functional recovery and, as a result of this, also reduce length-of-stay in hospital. There is no comprehensive framework available for pancreaticoduodenectomy.


METHODS
An international working group constructed within the Enhanced Recovery After Surgery (ERAS®) Society constructed a comprehensive and evidence-based framework for best perioperative care for pancreaticoduodenectomy patients. Data were retrieved from standard databases and personal archives. Evidence and recommendations were classified according to the GRADE system and reached through consensus in the group. The quality of evidence was rated "high", "moderate", "low" or "very low". Recommendations were graded as "strong" or "weak".


RESULTS
Comprehensive guidelines are presented. Available evidence is summarised and recommendations given for 27 care items. The quality of evidence varies substantially and further research is needed for many issues to improve the strength of evidence and grade of recommendations.


CONCLUSIONS
The present evidence-based guidelines provide the necessary platform upon which to base a unified protocol for perioperative care for pancreaticoduodenectomy. A unified protocol allows for comparison between centres and across national borders. It facilitates multi-institutional prospective cohort registries and adequately powered randomised trials.
Department of GI and HPB Surgery, University Hospital Northern Norway, Tromsø, Norway. lassen@unn.no
Kristoffer
K
Lassen
Marielle M E
MM
Coolsen
Karem
K
Slim
Francesco
F
Carli
José E
JE
de Aguilar-Nascimento
Markus
M
Schäfer
Rowan W
RW
Parks
Kenneth C H
KC
Fearon
Dileep N
DN
Lobo
Nicolas
N
Demartines
Marco
M
Braga
Olle
O
Ljungqvist
Cornelis H C
CH
Dejong
D032921:Consensus; D019317:Evidence-Based Medicine; D006801:Humans; D007902:Length of Stay; D015201:Meta-Analysis as Topic; D010179:Pancreas / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D019990:Perioperative Care / Q000379:methods*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic