Safety and feasibility of enhanced recovery after surgery in the patients underwent distal pancreatectomy for pancreatic cancer
Toru Aoyama1, Keisuke Kazama2, Masaaki Murakawa2, Yosuke Atsumi2, Manabu Shiozawa2, Makoto Ueno3, Manabu Morimoto3, Hideki Taniguchi4, Munetaka Masuda5, Soichiro Morinaga2
1 Department of Gastrointestinal Surgery, Kanagawa Cancer Center; Department of Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
2 Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
3 Department of Hepatobiliary Pancreatic Oncology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
4 Department of Anesthesiology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
5 Department of Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama 241-8515, Kanagawa Prefecture
Source of Support: None, Conflict of Interest: None
Purpose: This study assessed whether our enhanced recovery after surgery (ERAS) program for distal pancreatectomy (DP) is safe and feasible.
Patients and Methods: The subjects were patients who underwent consecutive DP between 2012 and 2014 at the Department of Gastrointestinal Surgery, Kanagawa Cancer Center. They received perioperative care according to ERAS program. All data were retrieved retrospectively. Outcome measures included postoperative mortality, morbidity, hospitalization, and 30-day readmission rate. Our ERAS program included 12 elements (4 preoperative elements, 3 intraoperative elements, and 5 postoperative elements).
Results: A total of 44 patients were studied. The overall incidence of morbidity was 29.5%, the incidence of mortality was 0%, and the incidence of readmission was 0%. Four preoperative elements and 3 intraoperative elements seemed feasible. Among the 5 postoperative elements, 4 elements seemed feasible, accounting 90%< performance rate however the early removal of catheters and drain seemed not feasible. The median postoperative hospital stay was 14 days (range: 8–39 days). The median postoperative hospital stay was 13 days (range: 8–27 days) in patients without postoperative complications while the median postoperative hospital stay was 26 days (range: 14–39 days) in patients with postoperative complications.
Conclusion: This study results suggested that our ERAS program is safe and feasible in patients who undergo DP. However, achieving compliance on the postoperative element, especially the removal of catcher and drain, was more challenging.