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 .
A prospective study of prophylactic long-acting octreotide in high-risk patients undergoing pancreaticoduodenectomy.
BACKGROUND Postoperative pancreatic fistula ( postoperative pancreatic fistula [ POPF ] ) is the most common complication after  pancreaticoduodenectomy . Despite some studies showing little effect of octreotide in unselected patients , we hypothesized that in high-risk patients depot octreotide may reduce the risk of POPF . METHODS Sixty-eight patients were prospect ively evaluated for inclusion in the current study . Two groups were identified : pancreatic ducts ≤3 mm ( high risk ) and those with ducts > 3 mm ( low risk ) . Thirty-two patients were low risk , whereas 36 patients were high risk . High-risk patients were treated preoperatively with depot octreotide and begun on an intravenous drip for 24 hours . Low-risk patients underwent pancreaticoduodenectomy without pharmacologic intervention . In contrast , the control cohort represents 106 retrospectively analyzed patients who underwent a pancreaticoduodenectomy without depot octreotide injection without regard to low- or high-risk status . RESULTS Overall , POPF was 11 of 68 ( 16 % ) . Nine of 36 high risk patients treated with depot octreotide developed POPF ( 25 % ) , and 2 of 32 low risk patients developed POPF ( 6 % ) . In the control cohort of high-risk patients , 9 of 44 ( 20 % ) and 3 of 62 ( 5 % ) low-risk patients developed POPF ( P = .628 when comparing the development of POPF in high-risk patients with or without pharmacologic intervention ) . CONCLUSIONS Prophylactic use of depot octreotide in high-risk patients does not result in reduced incidence of POPF . Duct size has a significant impact on the occurrence of POPF
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 .