A well-implemented ERAS protocol with good compliance is associated with a reduction in medical complications and length of hospital stay .
Enhanced recovery after surgery ( ERAS ) pathways are now implemented worldwide with strong evidence that adhesion to such protocol reduces medical complications , costs and hospital stay .
This concept has been applied for pancreatic surgery since the first published guidelines in 2012 .
This study presents the up date d ERAS recommendations for  pancreatoduodenectomy ( PD )  based on the best available evidence and on expert consensus .
Clinical and Immunological Impact of Early Postoperative Enteral Immunonutrition After Total Gastrectomy in Gastric Cancer Patients: A Prospective Randomized Study
Background Enteral immunodiet has been gaining increasing attention , but experimental data of its clinical effects in patients with gastric cancer are inconsistent , contradictory , and poorly investigated . The aim of this study was to assess the impact of early postoperative enteral immunonutrition on clinical and immunological outcomes in a homogeneous group of gastric cancer patients su bmi tted to total gastrectomy . Methods A total of 109 patients with gastric cancer were r and omized to receive early postoperative enteral immunonutrition ( formula supplemented with arginine , omega-3 fatty acids and ribonucleic acid [ RNA ] ) , or an isocaloric – isonitrogenous control . The postoperative outcome was evaluated based on clinical variables , including postoperative infectious complications , anastomotic leak rate , and length of hospitalization . In addition , state of cellular immunity was evaluated and compared between the 2 groups . Results The incidence of postoperative infectious complications in the immunodiet group ( 7.4 % ) was significantly ( p < .05 ) lower than that of the control group ( 20 % ) , as well as the anastomotic leak rate ( 3.7 % in immunodiet group vs 7.3 % in st and ard nutrition group , p < .05 ) . Mortality rate did not show any significant differences ; patients of the immunodiet group were found to have a significantly reduced length of hospitalization ( 12.7 ± 2.3 days ) when compared with st and ard diet group ( 15.9 ± 3.4 days , p = .029 ) . The data on cellular immunity showed that the postoperative CD4 + T-cell counts decreased in both groups , but the reduction in the IED group was significantly higher ( p = .032 ) compared with the SND group . Conclusions Early postoperative enteral immunonutrition significantly improves clinical and immunological outcomes in patients undergoing gastrectomy for gastric cancer
A well-implemented ERAS protocol with good compliance is associated with a reduction in medical complications and length of hospital stay .
Enhanced recovery after surgery ( ERAS ) pathways are now implemented worldwide with strong evidence that adhesion to such protocol reduces medical complications , costs and hospital stay .
This concept has been applied for pancreatic surgery since the first published guidelines in 2012 .
This study presents the up date d ERAS recommendations for  pancreatoduodenectomy ( PD )  based on the best available evidence and on expert consensus .