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 .
Early Enteral Versus Total Parenteral Nutrition in Patients Undergoing Pancreaticoduodenectomy: A Randomized Multicenter Controlled Trial (Nutri-DPC)
Objectives : The aim of this study was to compare nasojejunal early enteral nutrition ( NJEEN ) with total parenteral nutrition ( TPN ) , after pancreaticoduodenectomy ( PD ) , in terms of postoperative complications . Background : Current nutritional guidelines recommend the use of enteral over parenteral nutrition in patients undergoing gastrointestinal surgery . However , the NJEEN remains controversial in patients undergoing PD . Methods : Multicenter , r and omized , controlled trial was conducted between 2011 and 2014 . Nine centers in France analyzed 204 patients undergoing PD to NJEEN ( n = 103 ) or TPN ( n = 101 ) . Primary outcome was the rate of postoperative complications according to Clavien-Dindo classification . Successful NJEEN was defined as insertion of a nasojejunal feeding tube , delivering at least 50 % of nutritional needs on PoD 5 , and no TPN for more than consecutive 48 hours . Results : Postoperative complications occurred in 77.5 % [ 95 % confidence interval ( 95 % CI ) 68.1–85.1 ] patients in the NJEEN group versus 64.4 % ( 95 % CI 54.2–73.6 ) in TPN group ( P = 0.040 ) . NJEEN was associated with higher frequency of postoperative pancreatic fistula ( POPF ) ( 48.1 % vs 27.7 % , P = 0.012 ) and higher severity ( grade B/C 29.4 % vs 13.9 % ; P = 0.007 ) . There was no significant difference in the incidence of post-pancreatectomy hemorrhage , delayed gastric emptying , infectious complications , the grade of postoperative complications , and the length of postoperative stay . A successful NJEEN was achieved in 63 % patients . In TPN group , average energy intake was significantly higher ( P < 0.001 ) and patients had an earlier recovery of oral feeding ( P = 0.0009 ) . Conclusions : In patients undergoing PD , NJEEN was associated with an increased overall postoperative complications rate . The frequency and the severity of POPF were also significantly increased after NJEEN . In terms of safety and feasibility , NJEEN should not be recommended
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 .