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 .
Postoperative Complications Reduce Adjuvant Chemotherapy Use in Resectable Pancreatic Cancer
Objective : To assess the impact of postoperative complications on the receipt of adjuvant chemotherapy . Background : R and omized trials have demonstrated that adjuvant chemotherapy is associated with improved long-term survival . However , pancreatic surgery is associated with significant morbidity and the degree to which complications limit subsequent treatment options is unknown . Methods : Patients from the American College of Surgeons National Surgical Quality Improvement Program and the National Cancer Data Base who underwent pancreatic resection for cancer were linked ( 2006–2009 ) . The associations between complications and adjuvant chemotherapy use or treatment delay ( ≥70 days from surgery ) were assessed using multivariable regression methods . Results : From 149 hospitals , 2047 patients underwent resection for stage I-III pancreatic adenocarcinoma of which 23.2 % had at least 1 serious complication .  Overall adjuvant chemotherapy  receipt was 57.7 % : 61.8 % among patients not experiencing any complication and 43.6 % among those who had a serious complication . Serious complications increased the likelihood of not receiving adjuvant therapy over twofold [ odds ratio ( OR ) = 2.20 , 95 % confidence interval ( CI ) : 1.73–2.80 ] . Specific complications associated with adjuvant chemotherapy omission were reintubation ( OR = 7.79 , 95 % CI : 3.59–16.87 ) , prolonged ventilation ( OR = 5.92 , 95 % CI : 3.23–10.86 ) , pneumonia ( OR = 2.83 , 95 % CI : 1.63–4.90 ) , sepsis/shock ( OR = 2.76 , 95 % CI : 2.02–3.76 ) , organ space/deep surgical site infection ( OR = 2.19 , 95 % CI : 1.53–3.13 ) , venous thromboembolism ( OR = 1.92 , 95 % CI : 1.08–3.43 ) , and urinary tract infection ( OR = 1.61 , 95 % CI : 1.02–2.54 ) . Serious complications also doubled the likelihood of delaying adjuvant treatment administration ( OR = 2.08 , 95 % CI : 1.42–3.05 ) . Sensitivity analysis in a younger , healthier patient cohort demonstrated similar associations . Conclusions : Postoperative complications are common following pancreatic surgery and are associated with adjuvant chemotherapy omission and treatment delays
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 .