Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2016; 22(28): 6456-6468
Published online Jul 28, 2016. doi: 10.3748/wjg.v22.i28.6456
Enhanced recovery pathways in pancreatic surgery: State of the art
Nicolò Pecorelli, Sara Nobile, Stefano Partelli, Luca Cardinali, Stefano Crippa, Gianpaolo Balzano, Luigi Beretta, Massimo Falconi
Nicolò Pecorelli, Sara Nobile, Stefano Partelli, Stefano Crippa, Gianpaolo Balzano, Massimo Falconi, Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, “Vita-Salute” University, 20132 Milan, Italy
Luca Cardinali, Department of Surgery, Università Politecnica delle Marche, 60100 Ancona, Italy
Luigi Beretta, Department of Anesthesiology, San Raffaele Scientific Institute, “Vita-Salute” University, 20132 Milan, Italy
Author contributions: Pecorelli N designed the study, performed the literature review, drafted the manuscript and approved the final version; all other authors contributed to this paper in its critical revision and editing, and approved the final version.
Conflict-of-interest statement: No potential conflicts of interest, no financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Massimo Falconi, MD, Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
Telephone: +39-02-26436046 Fax: +39-02-26437807
Received: March 30, 2016
Peer-review started: April 5, 2016
First decision: May 12, 2016
Revised: May 21, 2016
Accepted: June 13, 2016
Article in press: June 13, 2016
Published online: July 28, 2016

Pancreatic surgery is being offered to an increasing number of patients every year. Although postoperative outcomes have significantly improved in the last decades, even in high-volume centers patients still experience significant postoperative morbidity and full recovery after surgery takes longer than we think. In recent years, enhanced recovery pathways incorporating a large number of evidence-based perioperative interventions have proved to be beneficial in terms of improved postoperative outcomes, and accelerated patient recovery in the context of gastrointestinal, genitourinary and orthopedic surgery. The role of these pathways for pancreatic surgery is still unclear as high-quality randomized controlled trials are lacking. To date, non-randomized studies have shown that care pathways for pancreaticoduodenectomy and distal pancreatectomy are safe with no difference in postoperative morbidity, leading to early discharge and no increase in hospital readmissions. Hospital costs are reduced due to better organization of care and resource utilization. However, further research is needed to clarify the effect of enhanced recovery pathways on patient recovery and post-discharge outcomes following pancreatic resection. Future studies should be prospective and follow recent recommendations for the design and reporting of enhanced recovery pathways.

Keywords: Pancreas surgery, Perioperative care, Length of stay, Postoperative complications, Pancreatic neoplasms, Evidence-based medicine

Core tip: In this study, we reviewed the available literature for enhanced recovery pathways in pancreatic surgery with a special focus on the evidence underlying specific perioperative interventions implemented in this surgical subspecialty and on postoperative outcomes. Although the quality of available studies is suboptimal, enhanced recovery proved to be safe and has the potential to reduce postoperative length of stay and costs after pancreatic resection. No evidence is available regarding post-discharge outcomes and patient functional recovery. Further research is needed to clarify the impact of care pathways on patient recovery after pancreatic surgery.