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 .
Prospective Evaluation of Pasireotide in Patients Undergoing Pancreaticoduodenectomy: The Washington University Experience.
BACKGROUND Pasireotide is a newer generation somatostatin analogue that led to a significant reduction in pancreatic fistula after pancreatectomy in a single-center r and omized controlled trial . We sought to determine if pasireotide reduces the incidence of pancreatic fistula and other complications after pancreaticoduodenectomy at our high volume center . STUDY DESIGN All patients undergoing pancreaticoduodenectomy between April 2011 and January 2017 were prospect ively followed , and their complications were grade d using the Modified Accordion Grading System ( MAGS ) in our institutional complications data base . For 18 months , 5 pancreatic surgeons used pasireotide routinely in patients undergoing pancreaticoduodenectomy . Patients receiving pasireotide were then propensity score-matched to patients who did not receive pasireotide , and their outcomes were compared . RESULTS There were 459 patients who underwent pancreaticoduodenectomy , and 127 patients ( 28 % ) received pasireotide .  Patients who received pasireotide were significantly more likely to have dilated pancreatic ducts and have a drain left at the time of surgery . Patients who received pasireotide had no difference in pancreatic fistula , overall complications , 90-day readmission , or 90-day mortality . However , patients who received pasireotide had a significantly reduced rate of postoperative bleeding/anemia ( 8.7 % vs 16.9 % , p = 0.03 ) . Among 112 propensity score-matched pairs , patients who received pasireotide did not have significantly different rates of pancreatic fistula , and the rates of severe ( MAGS grade s 3 to 6 ) pancreatic fistula were identical between the 2 groups ( 7.1 % vs 7.1 % , p = 1.00 ) . Matched patients who received pasireotide had significantly decreased postoperative bleeding/anemia ( 9.8 % vs 19.6 % , p = 0.04 ) . CONCLUSIONS Pasireotide did not reduce the incidence or severity of pancreatic fistulas after pancreaticoduodenectomy , but was associated with a decrease in postoperative bleeding/anemia . A multicenter r and omized trial is needed to accurately define the role of pasireotide in the postoperative management of pancreaticoduodenectomy patients
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 .