Enhanced recovery pathways in pancreatic surgery: State of the art.
Pancreatic surgery is being offered to an increasing number of patients every year. Although postoperative outcomes have significantly improved in the last decades, even in high-volume centers patients still experience significant postoperative morbidity and full recovery after surgery takes longer than we think. In recent years, enhanced recovery pathways incorporating a large number of evidence-based perioperative interventions have proved to be beneficial in terms of improved postoperative outcomes, and accelerated patient recovery in the context of gastrointestinal, genitourinary and orthopedic surgery. The role of these pathways for pancreatic surgery is still unclear as high-quality randomized controlled trials are lacking. To date, non-randomized studies have shown that care pathways for pancreaticoduodenectomy and distal pancreatectomy are safe with no difference in postoperative morbidity, leading to early discharge and no increase in hospital readmissions. Hospital costs are reduced due to better organization of care and resource utilization. However, further research is needed to clarify the effect of enhanced recovery pathways on patient recovery and post-discharge outcomes following pancreatic resection. Future studies should be prospective and follow recent recommendations for the design and reporting of enhanced recovery pathways.
Nicolò Pecorelli, Sara Nobile, Stefano Partelli, Stefano Crippa, Gianpaolo Balzano, Massimo Falconi, Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University, 20132 Milan, Italy.
Nicolò
N
Pecorelli
Nicolò Pecorelli, Sara Nobile, Stefano Partelli, Stefano Crippa, Gianpaolo Balzano, Massimo Falconi, Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University, 20132 Milan, Italy.
Sara
S
Nobile
Nicolò Pecorelli, Sara Nobile, Stefano Partelli, Stefano Crippa, Gianpaolo Balzano, Massimo Falconi, Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University, 20132 Milan, Italy.
Stefano
S
Partelli
Nicolò Pecorelli, Sara Nobile, Stefano Partelli, Stefano Crippa, Gianpaolo Balzano, Massimo Falconi, Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University, 20132 Milan, Italy.
Luca
L
Cardinali
Nicolò Pecorelli, Sara Nobile, Stefano Partelli, Stefano Crippa, Gianpaolo Balzano, Massimo Falconi, Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University, 20132 Milan, Italy.
Stefano
S
Crippa
Nicolò Pecorelli, Sara Nobile, Stefano Partelli, Stefano Crippa, Gianpaolo Balzano, Massimo Falconi, Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University, 20132 Milan, Italy.
Gianpaolo
G
Balzano
Nicolò Pecorelli, Sara Nobile, Stefano Partelli, Stefano Crippa, Gianpaolo Balzano, Massimo Falconi, Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University, 20132 Milan, Italy.
Luigi
L
Beretta
Nicolò Pecorelli, Sara Nobile, Stefano Partelli, Stefano Crippa, Gianpaolo Balzano, Massimo Falconi, Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University, 20132 Milan, Italy.
Massimo
M
Falconi
D002985:Clinical Protocols; D019317:Evidence-Based Medicine; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D010359:Patient Readmission; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications
Evidence-based medicine; Length of stay; Pancreas surgery; Pancreatic neoplasms; Perioperative care; Postoperative complications