A new enhanced recovery after surgery pathway for left-sided pancreatic cancer patients after distal pancreatectomy

BACKGROUND: Pancreatic surgeries are one of the most complex surgical procedures in general surgery that require highly experienced surgical technics and intensive postoperative care. Meanwhile the application of enhanced recovery after surgery (ERAS) program in pancreatic surgery is limited. The aim of this study was to attempt a new ERAS pathway specifically for patients after distal pancreatectomy (DP). METHODS: Between May 2016 and November 2016, 29 patients undergoing DP in Shanghai Ruijin Hospital pancreatic disease center received the ERAS pathway. Meanwhile 19 patients were implemented traditional care. Complications, readmissions, mortality, length of stay (LOS) and drainage-tube-off day were compared and evaluated in the two groups. RESULTS: Median length of stay was significantly reduced (18.37±2.55 days in ERAS group; 27.42±7.60 days in the control group) and drainage-tube-off days (5.89±2.41 versus 26.68±7.35 days). And no patient discharged with a drainage tube in ERAS group compared while 7 patients (36.8%) discharged with drainage tube in the conventional group. Postoperative pancreatic fistula (POPF) rate was decreased in ERAS group but not significantly. Readmission rates, as well as mortality, did not change over time. 9 patients were found postoperative abdominal fluid collections in ERAS group, and only 2 patients were confirmed real pancreatic fistula. CONCLUSIONS: Implementing the new ERAS program for DP may contribute to a decrease of LOS and drainage-tube-off days with a promising outcome. Therefore, an ERAS pathway specifically for DP should be established.