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 .
Comparison of Perioperative Outcomes Between Laparoscopic and Open Approach for Pancreatoduodenectomy: The PADULAP Randomized Controlled Trial
Objective : To compare perioperative outcomes of  pancreatoduodenectomy ( PD ) performed through the laparoscopic route or by open surgery . Summary Background Data : Laparoscopic PD is being progressively performed in selected patients . Methods : An open-label single-center RCT was conducted between February 2013 and September 2017 . The primary endpoint was the length of hospital stay ( LOS ) . Secondary endpoints were operative time , transfusion requirements , specific pancreatic complications ( pancreatic or biliary fistula , pancreatic hemorrhage , and delayed gastric emptying ) , Clavien – Dindo grade ≥ 3 complications , comprehensive complication index ( CCI ) score , poor quality outcome ( PQO ) , and the quality of pathologic resection . Analyses were performed on an intention to treat basis . Results : Of 86 patients assessed for PD , 66 were r and omized ( 34 laparoscopic approach , 32 open surgery ) . Conversion to an open procedure was needed in 8 ( 23.5 % ) patients . Laparoscopic versus open PD was associated with a significantly shorter LOS ( median 13.5 vs. 17 d ; P = 0.024 ) and longer median operative time ( 486 vs. 365 min ; P = 0.0001 ) . The laparoscopic approach was associated with significantly better outcomes regarding Clavien – Dindo grade ≥ 3 complications ( 5 vs. 11 patients ; P = 0.04 ) , CCI score ( 20.6 vs. 29.6 ; P = 0.038 ) , and PQO ( 10 vs. 14 patients ; P = 0.041 ) . No significant differences in transfusion requirements , pancreas-specific complications , the number of lymph nodes retrieved , and resection margins between the two approaches were found . Conclusions : Laparoscopic PD versus open surgery is associated with a shorter LOS and a more favorable postoperative course while maintaining oncological st and ards of a curative-intent surgical resection . Trial registry : IS RCT N93168938
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 .