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 .
Randomized, multicenter trial of antibiotic prophylaxis in elective colorectal surgery: single dose vs 3 doses of a second-generation cephalosporin without metronidazole and oral antibiotics.
HYPOTHESIS Use of prophylactic antibiotics in elective colorectal surgery is essential . Although single-dose prophylactic antibiotics are recommended , the efficacy of single-dose cephalosporin without metronidazole and oral antibiotics is not fully proven . We conducted a multicenter , r and omized trial of a single dose vs 3 doses of the second-generation cephalosporin cefmetazole . DESIGN A prospect i ve , r and omized , multicenter trial in patients undergoing elective colorectal surgery . SETTING Seven major hospitals in Japan that offer cancer treatment . PATIENTS Patients with colorectal cancer treated from May 6 , 2004 , to April 25 , 2005 . INTERVENTIONS Patients were r and omized to 1 of 2 groups : a single-dose group given a single dose of cefmetazole just before skin incision and a 3-dose group given 2 additional doses of cefmetazole every 8 hours after the first dose just before skin incision . MAIN OUTCOME MEASURES Incidences of incisional surgical site infection ( SSI ) , organ or space SSI , and all other infectious complications within 30 days after surgery . RESULTS A total of 384 patients were enrolled . Seven patients were excluded because of additional surgery or the inability to tolerate mechanical preparation . The incidence of incisional SSI was higher in the single-dose group ( 27/190 or 14.2 % ) than in the 3-dose group ( 8/187 or 4.3 % ) ( P = .009 ) . Incidences of organ or space SSI and other postoperative infectious diseases did not differ significantly between the 2 groups . In multivariate analysis , antibiotic dose was the only significant factor related to the incidence of incisional SSI . CONCLUSION Three-dose cefmetazole administration is significantly more effective for prevention of incisional SSI than single-dose antibiotic administration . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00292708
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 .