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 .
Pasireotide for postoperative pancreatic fistula.
BACKGROUND  Postoperative pancreatic fistula is a major contributor to complications and death associated with pancreatic resection . Pasireotide , a somatostatin analogue that has a longer half-life than octreotide and a broader binding profile , decreases pancreatic exocrine secretions and may prevent postoperative pancreatic fistula . METHODS We conducted a single-center , r and omized , double-blind trial of perioperative subcutaneous pasireotide in patients undergoing either pancreaticoduodenectomy or distal pancreatectomy . We r and omly assigned 300 patients to receive 900 μg of subcutaneous pasireotide ( 152 patients ) or placebo ( 148 patients ) twice daily beginning preoperatively on the morning of the operation and continuing for 7 days ( 14 doses ) . R and omization was stratified according to the type of resection and whether the pancreatic duct was dilated at the site of transection . The primary end point was the development of pancreatic fistula , leak , or abscess of grade 3 or higher ( i.e. , requiring drainage ) . RESULTS The primary end point occurred in 45 of the 300 patients ( 15 % ) . The rate of grade 3 or higher postoperative pancreatic fistula , leak , or abscess was significantly lower among patients who received pasireotide than among patients who received placebo ( 9 % vs. 21 % ; relative risk , 0.44 ; 95 % confidence interval [ CI ] , 0.24 to 0.78 ; P=0.006 ) . This finding was consistent among 220 patients who underwent pancreaticoduodenectomy ( 10 % vs. 21 % ; relative risk , 0.49 ; 95 % CI , 0.25 to 0.95 ) and 80 patients who underwent distal pancreatectomy ( 7 % vs. 23 % ; relative risk , 0.32 ; 95 % CI , 0.10 to 0.99 ) , as well as among 136 patients with a dilated pancreatic duct ( 2 % vs. 15 % ; relative risk , 0.11 ; 95 % CI , 0.02 to 0.60 ) and 164 patients with a nondilated pancreatic duct ( 15 % vs. 27 % ; relative risk , 0.55 ; 95 % CI , 0.29 to 1.01 ) . CONCLUSIONS Perioperative treatment with pasireotide decreased the rate of clinical ly significant postoperative pancreatic fistula , leak , or abscess . ( Funded by Novartis Pharmaceuticals ; Clinical Trials.gov number , NCT00994110 . )
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 .