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 .
Does Prophylactic Octreotide Decrease the Rates of Pancreatic Fistula and Other Complications After Pancreaticoduodenectomy?: Results of a Prospective Randomized Placebo-Controlled Trial
Objective To evaluate the endpoints of complications ( specifically pancreatic fistula and total complications ) and death in patients undergoing pancreaticoduodenectomy . Summary Background Data Four r and omized , placebo-controlled , multicenter trials from Europe have evaluated prophylactic octreotide ( the long-acting synthetic analog of native somatostatin ) in patients undergoing pancreatic resection . Each trial reported significant decreases in overall complication rates , and two of the four reported significantly lowered rates of pancreatic fistula in patients receiving prophylactic octreotide . However , none of these four trials studied only pancreaticoduodenal resections , and all trials had high pancreatic fistula rates ( > 19 % ) in the placebo group . A fifth r and omized trial from the United States evaluated the use of prophylactic octreotide in patients undergoing pancreaticoduodenectomy and found no benefit to the use of octreotide . Prophylactic use of octreotide adds more than $ 75 to the daily hospital charge in the United States . In calendar year 1996 , 288 patients received octreotide on the surgical service at the authors ’ institution , for total billed charges of $ 74,652 . Methods Between February 1998 and February 2000 , 383 patients were recruited into this study on the basis of preoperative anticipation of pancreaticoduodenal resection . Patients who gave consent were r and omized to saline control versus octreotide 250 & mgr;g subcutaneously every 8 hours for 7 days , to start 1 to 2 hours before surgery . The primary postoperative endpoints were pancreatic fistula , total complications , death , and length of hospital stay . Results Two hundred eleven patients underwent pancreaticoduodenectomy with pancreatic-enteric anastomosis , received appropriate saline/octreotide doses , and were available for endpoint analysis . The two groups were comparable with respect to demographics ( 54 % male , median age 66 years ) , type of pancreaticoduodenal resection ( 60 % pylorus-preserving ) , type of pancreatic-enteric anastomosis ( 87 % end-to-side pancreaticojejunostomy ) , and pathologic diagnosis . The pancreatic fistula rates were 9 % in the control group and 11 % in the octreotide group . The overall complication rates were 34 % in the control group and 40 % in the octreotide group ; the in-hospital death rates were 0 % versus 1 % , respectively . The median postoperative length of hospital stay was 9 days in both groups . Conclusions These data demonstrate that the prophylactic use of perioperative octreotide does not reduce the incidence of pancreatic fistula or total complications after pancreaticoduodenectomy . Prophylactic  octreotide use in this setting should be eliminated , at a considerable cost savings
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 .