Experience of implementing enhanced recovery program in pancreatic surgery

Aim. To assess the feasibility of enhanced recovery program for patients undergoing pancreatic surgery.

Materials and methods. Between January 2019 and May 2022, 47 patients with various pancreatic diseases underwent surgery at the University Clinic of A.I. Evdokimov Moscow State University of Medicine and Dentistry and FMBA of Russia. Male patients comprised 24 (51%), female – 23 (49%); the age of patients was 22 to 78 years (mean age 43.5 years). Pancreaticoduodenal resection was performed in 30 patients, distal pancreatic resection in 17 patients. All patients received some elements of the enhanced recovery program.

Results. An uneventful postoperative period was observed in 36 patients (76.6%). Gastric stasis developed in 4 cases (8.5%), pancreatic fistulas in 4 (8.5%), postoperative pancreatitis in 3 (6,4%). A reoperation was performed in 1 case (2.1%) with intra-abdominal bleeding. The average length of stay in the intensive care unit comprised 1.8 days.

Conclusion. The use of Fast Track in pancreatic surgery does not significantly increase the incidence of early postoperative complications, meanwhile it reduces the length of hospital stay after surgery and provides more cost- effective results. However, the development of a clear protocol for the management of patients requires further research and accumulation of data.

1. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br. J. Anaesth. 1997; 78 (5): 606–617. https://doi.org/10.1093/bja/78.5.606

2. Kehlet H., Wilmore D.W. Evidence-based surgical care and the evolution of fast-track surgery. Ann. Surg. 2008; 248 (2): 189–198. https://doi.org/10.1097/SLA.0b013e31817f2c1a

3. XII Congress of Russian Surgeons. Pirogov Russian Journal of Surgery = Khirurgiya. Zurnal im. N.I. Pirogova. 2015; 11: 102–102. https://doi.org/10.17116/hirurgia201511102 (In Russian)

4. Hall T.C., Dennison A.R., Bilku D.K., Metcalfe M.S., Garcea G. Enhanced recovery programmes in hepatobiliary and pancreatic surgery: a systematic review. Ann. R. Coll. Surg. Engl. 2012; 94 (5): 318–326. https://doi.org/10.1308/003588412X13171221592410

5. di Sebastiano P., Festa L., De Bonis A., Ciuffreda A., Valvano M.R., Andriulli A., di Mola F.F. A modified fast-track program for pancreatic surgery: a prospective single-center experience. Langenbecks Arch. Surg. 2011; 396 (3): 345–351. https://doi.org/10.1007/s00423-010-0707-1

6. Pasechnik I.N., Nazarenko A.G., Gubaidullin R.R., Skobelev E.I., Borisov A.Yu. Modern approaches to enhanced recovery after surgery. Doctor.ru. 2015; 15 (116) – 16 (117): 10–17. (In Russian)

7. Lillemoe H.A., Aloia Th.A. Enhanced recovery after surgery: hepatobiliary. Surg. Clin. North. Am. 2018; 98 (6): 1251–1264. https://doi.org/10.1016/j.suc.2018.07.011

8. Fazzalari A., Srinivas S., Panjwani S., Pozzi N., Friedrich A., Sheoran R., Sabato J., Durocher D., Reznek M., Aiello F., Litwin D., Cahan M.A. A Fast-Track pathway for emergency general surgery at an academic medical center. J. Surg. Res. 2021; 267: 1–8. https://doi.org/10.1016/j.jss.2021.04.012

9. Chugunova O.A., Dzyadzko A.M., Katin M.L., Korotkov S.V., Rummo O.O. Key principles of the enhanced recovery after surgery. Application of fast-track protocols in hepatobiliary surgery. Surgery. Eastern Europe. 2016; 5 (1): 144–156. (In Russian)