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 .
Risk factors, complications and survival after upper abdominal surgery: a prospective cohort study
Background Preoperative weight loss and abnormal serum-albumin have traditionally been associated with reduced survival . More recently , a correlation between postoperative complications and reduced long-term survival has been reported and the significance of the relative proportion of skeletal muscle , visceral and subcutaneous adipose tissue has been examined with conflicting results . We investigated how preoperative body composition and major non-fatal complications related to overall survival and compared this to established predictors in a large cohort undergoing upper abdominal surgery .  Methods From 2001 to 2006 , 447 patients were included in a Norwegian multicenter r and omized controlled trial in major upper abdominal surgery .  Patients were now , six years later , analyzed as a single prospect i ve cohort and overall survival was retrieved from the National Population Registry . Body composition indices were calculated from CT images taken within three months preoperatively . Results Preoperative serum-albumin < 35 g/l ( HR = 1.52 , p = 0 .014 ) and weight loss > 5 % ( HR = 1.38 , p = 0.023 ) were independently associated with reduced survival . There was no association between any of the preoperative body composition indices and reduced survival . Major postoperative complications were independently associated with reduced survival but only as long as patients who died within 90 days were included in the analysis . Conclusions Our study has confirmed the robust significance of the traditional indicators , preoperative serum-albumin and weight loss . The body composition indices did not prove beneficial as global indicators of poor prognosis in upper abdominal surgery . We found no association between non-fatal postoperative complications and long-term survival
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 .