Программы ускоренной реабилитации пациентов после операций на поджелудочной железе

Цель работы – осветить основные компоненты программ ускоренной реабилитации, сравнить результаты традиционных операций на поджелудочной железе, выполненных по этим программам, а также представить возможные перспективы этого направления. Число операций на поджелудочной железе значительно увеличилось. Несмотря на значительное уменьшение послеоперационной летальности, частота осложнений остается значительной даже в специализированных центрах. Полное восстановление качества жизни больных после операции занимает продолжительное время. Концепция ускоренной реабилитации после операций, основанная на принципах доказательной медицины, показала эффективность в отдельных областях абдоминальной хирургии. Однако роль этой концепции в хирургической панкреатологии не уточнена. Нерандомизированные и отдельные рандомизированные исследования показали, что применение протоколов ускоренной реабилитации пациентов, оперированных на поджелудочной железе, является безопасным, позволяет уменьшить продолжительность пребывания в стационаре после операции без увеличения числа осложнений и летальности.

1. Amini N., Spolverato G., Kim Y., Pawlik T.M. Trends in hospital volume and failure to rescue for pancreatic surgery. J. Gastrointest. Surg. 2015; 19 (9): 1581–1592. https://doi.org/10.1007/s11605-015-2800-9.

2. Gooiker G.A., Lemmens V.E., Besselink M.G., Busch O.R., Bonsing B.A., Molenaar I.Q., Tollenaar R.A., de Hingh I.H., Wouters M.W. Impact of centralization of pancreatic cancer surgery on resection rates and survival. Br. J. Surg. 2014; 101 (8): 1000–1005. https://doi.org/10.1002/bjs.9468.

3. Рогаль М.Л., Иванов П.А., Ярцев П.А., Смоляр А.Н., Киселев Е.А. Результаты выполнения панкреатодуоденаль- ной резекции в специализированном отделении многопрофильного стационара. Журнал им. Н.В. Склифосовского “Неотложная медицинская помощь”. 2016; 1: 54–58.

4. Eaton A.A., Gonen M., Karanicolas P., Jarnagin W.R., D’Angelica M.I., DeMatteo R., Kingham T.P., Allen P.J. Healthrelated quality of life after pancreatectomy: results from a randomized controlled trial. Ann. Surg. Oncol. 2016; 23 (7): 2137–2145. https://doi.org/10.1245/s10434-015-5077-z.

5. 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.

6. Schultz N.A., Larsen P.N., Klarskov B., Plum L.M., Frederiksen H.J., Christensen B.M., Kehlet H., Hillingsø J.G. Evaluation of a fast-track programme for patients undergoing liver resection. Br. J. Surg. 2013; 100 (1): 138–143. https://doi.org/10.1002/bjs.8996.

7. Агеенко А.М., Садовой М.А., Шелякина О.В., Овтин М.А. Технология ускоренной реабилитации после эндопротезирования тазобедренного и коленного суставов (обзор литературы). Травматология и ортопедия России. 2017; 23 (4): 146–155.

8. Nicholson A., Lowe M.C., Parker J., Lewis S.R., Alderson P., Smith A.F. Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br. J. Surg. 2014; 101 (3): 172–188. https://doi.org/10.1002/bjs.9394.

9. Lassen K., Coolsen M.M., Slim K., Carli F., de Aguilar- Nascimento J.E., Schäfer M., Parks R.W., Fearon K.C., Lobo D.N., Demartines N., Braga M., Ljungqvist O., Dejong C.H. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World J. Surg. 2013; 37 (2): 240–258. https://doi.org/10.1007/s00268-012-1771-1.

10. Smith M.D., McCall J., Plank L., Herbison G.P., Soop M., Nygren J. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst. Rev. 2014; 8: CD009161. https://doi.org/10.1002/14651858.CD009161.pub2.

11. Buhrman W.C., Lyman W.B., Kirks R.C., Passeri M., Vrochides D. Current state of Enhanced Recovery After Surgery in hepatopancreatobiliary surgery. J. Laparoendosc. Adv. Surg. Tech. A. 2018; 28 (12): 1471–1475. https://doi.org/10.1089/lap.2018.0314.

12. De Pastena M., Marchegiani G., Paiella S., Malleo G., Ciprani D., Gasparini C., Secchettin E., Salvia R., Gabbrielli A., Bassi C. Impact of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy: an analysis of 1500 consecutive cases. Dig. Endosc. 2018; 30 (6): 777–784. https://doi.org/10.1111/den.13221.

13. Boulay B.R., Parepally M. Managing malignant biliary obstruction in pancreas cancer: choosing the appropriate strategy. World J. Gastroenterol. 2014; 20 (28): 9345–9353. https://doi.org/10.3748/wjg.v20.i28.9345.

14. Dorcaratto D., Hogan N.M., Muñoz E., Garcés M., Limongelli P., Sabater L., Ortega J. Is percutaneous transhepatic biliary drainage better than endoscopic drainage in the management of jaundiced patients awaiting pancreaticoduodenectomy? A systematic review and meta-analysis. J. Vasc. Interv. Radiol. 2018; 29 (5): 676–687. https://doi.org/10.1016/j.jvir.2017.12.027.

15. Nakamura K., Sho M., Akahori T., Nagai M., Nishiwada S., Nakagawa K., Tanaka T., Kichikawa K., Tamamoto T., Hasegawa M., Mitoro A., Yoshiji H., Ikeda N. A comparison between plastic and metallic biliary stent placement in patients receiving preoperative neoadjuvant chemoradiotherapy for resectable pancreatic cancer. World J. Surg. 2019; 43 (2): 642–648. https://doi.org/10.1007/s00268-018-4820-6.

16. Liu P., Lin H., Chen Y., Wu Y.S., Tang M., Liu C. Comparison of metal and plastic stents for preoperative biliary drainage in resectable and borderline resectable periampullary cancer: a meta-analysis and system review. J. Laparoendosc. Adv. Surg. Tech. A. 2018; 28 (9): 1074–1082. https://doi.org/10.1089/lap.2018.0029.

17. Andrianello S., Marchegiani G., Bannone E., Masini G., Malleo G., Montemezzi G.L., Polati E., Bassi C., Salvia R. Clinical implications of intraoperative fluid therapy in pancreatic surgery. J. Gastrointest. Surg. 2018; 22 (12): 2072–2079. https://doi.org/10.1007/s11605-018-3887-6.

18. Huang Y., Chua T.C., Gill A.J., Samra J.S. Impact of perioperative fluid administration on early outcomes after pancreatoduodenectomy: a meta-analysis. Pancreatology. 2017; 17 (3): 334–341. https://doi.org/10.1016/j.pan.2017.02.014.

19. Dichtwald S., Ben-Haim M., Papismedov L., Hazan S., Cattan A., Matot I. Intrathecal morphine versus intravenous opioid administration to impact postoperative analgesia in hepatopancreatic surgery: a randomized controlled trial. J. Anesth. 2017; 31 (2): 237–245. https://doi.org/10.1007/s00540-016-2286-y.

20. Boisen M.L., McQuaid A.J., Esper S.A., Holder-Murray J., Zureikat A.H., Hogg M.E., Paronish J., Subramaniam K. Intrathecal morphine versus nerve blocks in an enhanced recovery pathway for pancreatic surgery. J. Surg. Res. 2019; 244: 15–22. https://doi.org/10.1016/j.jss.2019.05.049.

21. Aloia T.A., Kim B.J., Segraves-Chun Y.S., Cata J.P., Truty M.J., Shi Q., Holmes A., Soliz J.M., Popat K.U., Rahlfs T.F., Lee J.E., Wang X.S., Morris J.S., Gottumukkala V.N.R., Vauthey J.N. A randomized controlled trial of postoperative thoracic epidural analgesia versus intravenous patient-controlled analgesia after major hepatopancreatobiliary surgery. Ann. Surg. 2017; 266 (3): 545–554. https://doi.org/10.1097/SLA.0000000000002386.

22. Laks S., Isaak R.S., Strassle P.D., Hance L., Kolarczyk L.M., Kim H.J. Increased intraoperative vasopressor use as part of an enhanced recovery after surgery pathway for pancreatectomy does not increase risk of pancreatic fistula. J. Pancreat. Cancer. 2018; 4 (1): 33–40. https://doi.org/10.1089/pancan.2018.0007.

23. Groen J.V., Slotboom D.E.F., Vuyk J., Martini C.H., Dahan A., Vahrmeijer A.L., Bonsing B.A., Mieog J.S.D. Epidural and nonepidural analgesia in patients undergoing open pancreatectomy: a retrospective cohort study. J. Gastrointest. Surg. 2019; Feb 26. https://doi.org/10.1007/s11605-019-04136-w.

24. Gaignard E., Bergeat D., Courtin-Tanguy L., Rayar M., Merdrignac A., Robin F., Boudjema K., Beloeil H., Meunier B., Sulpice L. Is systematic nasogastric decompression after pancrea ticoduodenectomy really necessary? Langenbecks. Arch. Surg. 2018; 403 (5): 573–580. https://doi.org/10.1007/s00423-018-1688-8.

25. Coolsen M.M., van Dam R.M., Chigharoe A., OldeDamink S.W., Dejong C.H. Improving outcome after pancreaticoduodenectomy: experiences with implementing an Enhanced Recovery After Surgery (ERAS) program. Dig. Surg. 2014; 31 (3): 177–184. https://doi.org/10.1159/000363583.

26. Panwar R., Pal S. The International Study Group of Pancreatic Surgery definition of delayed gastric emptying and the effects of various surgical modifications on the occurrence of delayed gastric emptying after pancreatoduodenectomy. Hepatobiliary Pancreat. Dis. Int. 2017; 16 (4): 353–363. https://doi.org/10.1016/S1499-3872(17)60037-7.

27. Short V., Herbert G., Perry R., Atkinson C., Ness A.R., Penfold C., Thomas S., Andersen H.K., Lewis S.J. Chewing gum for postoperative recovery of gastrointestinal function. Cochrane Database Syst. Rev. 2015; 2: CD006506. https://doi.org/10.1002/14651858. CD006506.pub3.

28. Andersson T., Bjerså K., Falk K., Olsén M.F. Effects of chewing gum against postoperative ileus after pancreaticoduodenectomy – a randomized controlled trial. BMC Res. Notes. 2015; 8: 37. https://doi.org/10.1186/s13104-015-0996-0.

29. Joliat G.R., Labgaa I., Demartines N., Schäfer M., Allemann P. Effect of antecolic versus retrocolicgastroenteric reconstruction after pancreaticoduodenectomy on delayed gastric emptying: a meta-analysis of six randomized controlled trials. Dig. Surg. 2016; 33 (1): 15–25. https://doi.org/10.1159/000441480.

30. Apfel C.C., Greim C.A., Haubitz I., Goepfert C., Usadel J., Sefrin P., Roewer N. A risk score to predict the probability of postoperative vomiting in adults. Acta Anaesthesiol. Scand. 1998; 42 (5): 495–501.

31. Gan T.J., Diemunsch P., Habib A.S., Kovac A., Kranke P., Meyer T.A., Watcha M., Chung F., Angus S., Apfel C.C., Bergese S.D., Candiotti K.A., Chan M.T., Davis P.J., Hooper V.D., Lagoo-Deenadayalan S., Myles P., Nezat G., Philip B.K., Tramèr M.R. Society for Ambulatory Anesthesia. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth. Analg. 2014; 118 (1): 85–113. https://doi.org/10.1213/ANE.0000000000000002.

32. Van Buren G. 2nd, Bloomston M., Hughes S.J., Winter J., Behrman S.W., Zyromski N.J., Vollmer C., Velanovich V., Riall T., Muscarella P., Trevino J., Nakeeb A., Schmidt C.M., Behrns K., Ellison E.C., Barakat O., Perry K.A., Drebin J., House M., Abdel-Misih S., Silberfein E.J., Goldin S., Brown K., Mohammed S., Hodges S.E., McElhany A., Issazadeh M., Jo E., Mo Q., Fisher W.E. A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann. Surg. 2014; 259 (4): 605–612. https://doi.org/10.1097/SLA.0000000000000460.

33. Hüttner F.J., Probst P., Knebel P., Strobel O., Hackert T., Ulrich A., Büchler M.W., Diener M.K. Meta-analysis of prophylactic abdominal drainage in pancreatic surgery. Br. J. Surg. 2017; 104 (6): 660–668. https://doi.org/10.1002/bjs.10505.

34. Zhang W., He S., Cheng Y., Xia J., Lai M., Cheng N., Liu Z. Prophylactic abdominal drainage for pancreatic surgery. Cochrane Database Syst. Rev. 2018; 6: CD010583. https://doi.org/10.1002/14651858.CD010583.pub4.

35. Wang Z., Chen J., Su K., Dong Z. Abdominal drainage versus no drainage post-gastrectomy for gastric cancer. Cochrane Database Syst. Rev. 2015; 5: CD008788. https://doi.org/10.1002/14651858.CD008788.pub3.

36. Serene T.E.L., G S.V., Padmakumar J.S., Terence H.C.W., Keem L.J., Bei W., Winston W.W.L. Predictive value of postoperative drain amylase levels for post-operative pancreatic fistula. Ann. Hepatobiliary Pancreat. Surg. 2018; 22 (4): 397–404. https://doi.org/10.14701/ahbps.2018.22.4.397.

37. Gianotti L., Besselink M.G., Sandini M., Hackert T., Conlon K., Gerritsen A., Griffin O., Fingerhut A., Probst P., Abu Hilal M., Marchegiani G., Nappo G., Zerbi A., Amodio A., Perinel J., Adham M., Raimondo M., Asbun H.J., Sato A., Takaori K., Shrikhande S.V., Del Chiaro M., Bockhorn M., Izbicki J.R., Dervenis C., Charnley R.M., Martignoni M.E., Friess H., de Pretis N., Radenkovic D., Montorsi M., Sarr M.G., Vollmer C.M., Frulloni L., Büchler M.W., Bassi C. Nutritional support and therapy in pancreatic surgery: a position paper of the International Study Group on Pancreatic Surgery (ISGPS). Surgery. 2018; 164 (5): 1035–1048. https://doi.org/10.1016/j.surg.2018.05.040.

38. Perinel J., Mariette C., Dousset B., Sielezneff I., Gainant A., Mabrut J.Y., Bin-Dorel S., Bechwaty M.E., Delaunay D., Bernard L., Sauvanet A., Pocard M., Buc E., Adham M. Early enteral versus total parenteral nutrition in patients undergoing pancreaticoduodenectomy: a randomized multicenter controlled trial (Nutri-DPC). Ann. Surg. 2016; 264 (5): 731–737. https://doi.org/10.1097/SLA.0000000000001896.

39. Gerritsen A., Wennink R.A., Besselink M.G., van Santvoort H.C., Tseng D.S., Steenhagen E., BorelRinkes I.H., Molenaar I.Q. Early oral feeding after pancreatoduodenectomy enhances recovery without increasing morbidity. HPB (Oxford). 2014; 16 (7): 656–664. https://doi.org/10.1111/hpb.12197.

40. Allen P.J., Gönen M., Brennan M.F., Bucknor A.A., Robinson L.M., Pappas M.M., Carlucci K.E., D'Angelica M.I., DeMatteo R.P., Kingham T.P., Fong Y., Jarnagin W.R. Pasireotide for postoperative pancreatic fistula. N. Engl. J. Med. 2014; 370 (21): 2014–2022. https://doi.org/10.1056/NEJMoa1313688.

41. Adiamah A., Arif Z., Berti F., Singh S., Laskar N., Gomez D. The use of prophylactic somatostatin therapy following pancreaticoduodenectomy: a meta-analysis of randomised controlled trials. World J. Surg. 2019; 43 (7): 1788–1801. https://doi.org/10.1007/s00268-019-04956-6.

42. Han X., Xu Z., Cao S., Zhao Y., Wu W. The effect of somatostatin analogues on postoperative outcomes following pancreatic surgery: a meta-analysis. PLoS One. 2017; 12 (12): e0188928. https://doi.org/10.1371/journal.pone.0188928.

43. Maessen J., Dejong C.H., Hausel J., Nygren J., Lassen K., Andersen J., Kessels A.G., Revhaug A., Kehlet H., Ljungqvist O., Fearon K.C., von Meyenfeldt M.F. A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br. J. Surg. 2007; 94 (2): 224–231. https://doi.org/10.1002/bjs.5468.

44. Castelino T., Fiore J.F. Jr., Niculiseanu P., Landry T., Augustin B., Feldman L.S. The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: a systematic review. Surgery. 2016; 159 (4): 991–1003. https://doi.org/10.1016/j.surg.2015.11.029.

45. Nikfarjam M., Weinberg L., Low N., Fink M.A., Muralidharan V., Houli N., Starkey G., Jones R., Christophi C. A fast track recovery program significantly reduces hospital length of stay following uncomplicated pancreaticoduodenectomy. JOP. 2013; 14 (1): 63–70. https://doi.org/10.6092/1590-8577/1223.

46. Nussbaum D.P., Penne K., Speicher P.J., Stinnett S.S., Perez A., White R.R., Clary B.M., Tyler D.S., Blazer D.G. The role of clinical care pathways: an experience with distal pancreatectomy. J. Surg. Res. 2014; 190 (1): 64–71. https://doi.org/10.1016/ j.jss.2014.02.026.

47. Kobayashi S., Ooshima R., Koizumi S., Katayama M., Sakurai J., Watanabe T., Nakano H., Imaizumi T., Otsubo T. Perioperative care with fast-track management in patients undergoing pancreaticoduodenectomy. World J. Surg. 2014; 38 (9): 2430– 2437. https://doi.org/10.1007/s00268-014-2548-5.

48. Braga M., Pecorelli N., Ariotti R., Capretti G., Greco M., Balzano G., Castoldi R., Beretta L. Enhanced recovery after surgery pathway in patients undergoing pancreaticoduodenectomy. World J. Surg. 2014; 38 (11): 2960–2966. https://doi.org/10.1007/ s00268-014-2653-5.

49. Shao Z., Jin G., Ji W., Shen L., Hu X. The role of fast-track surgery in pancreaticoduodenectomy: a retrospective cohort study of 635 consecutive resections. Int. J. Surg. 2015; 15: 129–133. https://doi.org/10.1016/j.ijsu.2015.01.007.

50. Sutcliffe R.P., Hamoui M., Isaac J., Marudanayagam R., Mirza D.F., Muiesan P., Roberts J.K. Implementation of an enhanced recovery pathway after pancreaticoduodenectomy in patients with low drain fluid amylase. World J. Surg. 2015; 39 (8): 2023–2030. https://doi.org/10.1007/s00268-015-3051-3.

51. Joliat G.R., Labgaa I., Petermann D., Hübner M., Griesser A.C., Demartines N., Schäfer M. Cost-benefit analysis of an enhanced recovery protocol for pancreaticoduodenectomy. Br. J. Surg. 2015; 102 (13): 1676–1683. https://doi.org/10.1002/bjs.9957.

52. Morales Soriano R., Esteve Pérez N., TejadaGavela S., CuadradoGarcía Á., Rodríguez Pino J.C., MorónCanis J.M., Molina Romero X., Muñoz Pérez J., González Argente X. Outcomes of an enhanced recovery after surgery programme for pancreaticoduodenectomy. Cir. Esp. 2015; 93 (8): 509–515. https://doi.org/10.1016/ j.ciresp.2015.04.009.

53. Richardson J., Di Fabio F., Clarke H., Bajalan M., Davids J., Abu Hilal M. Implementation of enhanced recovery programme for laparoscopic distal pancreatectomy: feasibility, safety and cost analysis. Pancreatology. 2015; 15 (2): 185–190. https://doi.org/10.1016/j.pan.2015.01.002.

54. Lei Q., Wang X., Tan S., Wan X., Zheng H., Li N. Application of enhanced recovery after surgery program in perioperative management of pancreaticoduodenectomy: a systematic review. Zhonghua. Wei Chang WaiKeZaZhi. 2015; 18 (2):143–149.

55. Xiong J., Szatmary P., Huang W., de la Iglesia-Garcia D., Nunes Q.M., Xia Q., Hu W., Sutton R., Liu X., Raraty M.G. Enhanced recovery after surgery program in patients undergoing pancreaticoduodenectomy: a PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2016; 95 (18): e3497. https://doi.org/10.1097/MD.0000000000003497.

56. Pecorelli N., Capretti G., Balzano G., Castoldi R., Maspero M., Beretta L., Braga M. Enhanced recovery pathway in patients undergoing distal pancreatectomy: a case-matched study. HPB. 2017; 19 (3): 270–278. https://doi.org/10.1016/j.hpb.2016.10.014.

57. Коваленко З.А., Лядов В.К., Лядов К.В. Ускоренная послеоперационная реабилитация пациентов, перенесших панкреатодуоденальную резекцию. Хирургия. Журнал им. Н.И. Пирогова. 2017; 8: 40–46. https://doi.org/10.17116/hirurgia2017840-46.

58. Takagi K., Yoshida R., Yagi T., Umeda Y., Nobuoka D., Kuise T., Hinotsu S., Matsusaki T., Morimatsu H., Eguchi J., Wada J., Senda M., Fujiwara T. Effect of an Enhanced Recovery After Surgery protocol in patients undergoing pancreaticoduodenectomy: a randomized controlled trial. Clin. Nutr. 2019; 38 (1): 174–181. https://doi.org/10.1016/j.clnu.2018.01.002.