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 oral feeding after pancreatoduodenectomy enhances recovery without increasing morbidity.
OBJECTIVE The aim of this study was to evaluate whether a change in the routine feeding strategy applied after pancreatoduodenectomy ( PD ) from nasojejunal tube ( NJT ) feeding to early oral feeding improved clinical outcomes . METHODS An observational cohort study was performed in 102 consecutive patients undergoing PD . In period 1 ( n = 51 , historical controls ) , the routine postoperative feeding strategy was NJT feeding . This was changed to a protocol of early oral feeding with on-dem and NJT feeding in period 2 ( n = 51 , consecutive prospect i ve cohort ) . The primary outcome was time to resumption of adequate oral intake . RESULTS The baseline characteristics of study subjects in both periods were comparable . In period 1 , 98 % ( n = 50 ) of patients received NJT feeding , whereas in period 2 , 53 % ( n = 27 ) of patients did so [ for delayed gastric empting ( DGE ) ( n = 20 ) or preoperative malnutrition ( n = 7 ) ] . The time to resumption of adequate oral intake significantly decreased from 12 days in period 1 to 9 days in period 2 ( P = 0.015 ) , and the length of hospital stay shortened from 18 days in period 1 to 13 days in period 2 ( P = 0.015 ) . Overall , there were no differences in the incidences of complications of Clavien-Dindo Grade III or higher , DGE , pancreatic fistula , postoperative haemorrhage and mortality between the two periods . CONCLUSIONS The introduction of an early oral feeding strategy after PD reduced the time to resumption of adequate oral intake and length of hospital stay without negatively impacting postoperative morbidity
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 .