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 .
Preoperative Oral Supplementation with Long-Chain Ω-3 Fatty Acids Beneficially Alters Phospholipid Fatty Acid Patterns in Liver, Gut Mucosa, and Tumor Tissue.
BACKGROUND The uptake of ω-3 polyunsaturated fatty acids ( PUFAs ) into the liver , gut mucosa , and tumor tissue and plasma levels after preoperative administration of supplemented enteral nutrition was investigated in patients with malignancies of the upper gastrointestinal tract . The objective of the study was to evaluate the incorporation of preoperatively administrated PUFAs , eicosapentaenoic acid ( EPA ) , and docosahexaenoic acid ( DHA ) into cell phospholipids . METHODS Patients undergoing major gastrointestinal surgery ( n = 40 ) were prospect ively r and omized to receive a PUFA-supplemented liquid oral diet 5 days preoperatively or an isocaloric control diet . The planned diet intake was 1000 mL/d providing 3.7 g of PUFA . The diet was given in addition to the usual hospital diet . The phospholipid fractions in plasma were analyzed on the day of surgery . Tissue sample s of liver , gut mucosa ( small intestine ) , and tumor were taken during surgery and homogenized . EPA and DHA content was analyzed using liquid gas chromatography . RESULTS Both patient groups ( PUFA group : n = 20 ; control group : n = 20 ) were similar in age , weight , and surgical procedures . As compared with the control group , the PUFA group had significantly increased levels of EPA in liver tissue ( 0.4 vs 1.3 weight % ) , gut mucosa ( 0.3 vs 1.0 weight % ) , and tumor tissue ( 0.3 vs 0.8 weight % ) . Also , the DHA levels in the PUFA group were significantly higher than the control group : liver tissue ( 4.1 vs 7.5 weight % ) , gut mucosa ( 2.1 vs 3.7 weight % ) and tumor tissue ( 1.9 vs 4.2 weight % ) . CONCLUSIONS This study suggests that administration of PUFA-enriched diets leads to increased incorporation of EPA and DHA not only in liver and gut mucosa tissue , but also in tumor tissue in patients with solid gastrointestinal tumors . Thus , preoperative administration of oral PUFA-enriched diets could have an impact on the postoperative inflammatory response after major abdominal surgery
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 .