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 Versus Late Drain Removal After Standard Pancreatic Resections: Results of a Prospective Randomized Trial
Summary of Background Data : The role of surgically placed intra-abdominal drainages after pancreatic resections has not been clearly established . In particular , their effect on morbidity rates and the optimal timing for their removal remains controversial . Methods : A total of 114 eligible patients who underwent st and ard pancreatic resections and at low risk of postoperative pancreatic fistula according to our institutional protocol ( amylase value in drains ≤5000 U/L on postoperative day [ POD ] 1 ) were r and omized on POD 3 to receive either early ( POD 3 ) or st and ard drain removal ( POD 5 or beyond ) . The primary end point of the study was the incidence of pancreatic fistula . Secondary endpoints included abdominal complications , pulmonary complications , in-hospital stay , and perioperative mortality . Cost- analysis between the 2 groups was also made . Results : Early drain removal was associated with a decreased rate of pancreatic fistula ( P = 0.0001 ) , abdominal complications ( P = 0.002 ) , and pulmonary complications ( P = 0.007 ) . Median in-hospital stay was shorter ( P = 0.018 ) , and hospital costs decreased ( P = 0.02 ) . Mortality was nil . A significant association with pancreatic fistula was found for timing of drain removal ( P < 0.001 ) , unintentional weight decrease before surgery ( P = 0.022 ) , type of pancreas texture ( P = 0.015 ) , serum amylase levels on POD 1 ( P = 0.001 ) , and albumin levels on POD 1 ( P = 0.039 ) . Multivariate analysis showed that timing of drain removal ( P = 0.0003 ) and unintentional weight decrease before surgery ( P = 0.02 ) were independent risk factors of pancreatic fistula . Conclusions : In patients at low risk of pancreatic fistula  , intra-abdominal drains can be safely removed on POD 3 after st and ard pancreatic resections . A prolonged period of drain insertion is associated with a higher rate of postoperative complications with increased hospital stay and costs . The manuscript is a r and omized trial , registered in the NLM data base as NCT00931554
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 .