Yasser Debakey, Mohamed Saber Mostafa, Ahmed Refaat, Sayed Shaker Sheier, Amr Nofal
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引用次数: 0
Abstract
Background: Enhanced Recovery After Surgery (ERAS) pathways have been increasingly adopted in gastrointestinal surgery; however, their application to pancreatoduodenectomy (PD) remains variable due to concerns regarding postoperative morbidity and safety (1-3). This study aimed to evaluate the impact of ERAS on postoperative outcomes and the feasibility of ultra-early discharge following PD.
Methods: A multicenter cohort study was conducted including 180 patients undergoing PD across four tertiary hepatopancreatobiliary centers. Sixty patients were managed prospectively under a standardized ERAS protocol, while 120 patients treated prior to ERAS implementation served as controls. Postoperative outcomes, including pancreatic fistula and delayed gastric emptying defined according to established criteria, were analyzed (4,5). Multivariate logistic regression was performed to identify predictors of discharge within ≤ 100 h.
Results: Baseline characteristics were comparable between groups. ERAS compliance exceeded 83% across key perioperative domains. Rates of clinically relevant pancreatic fistula were similar between groups (3.3% vs. 2.5%, p > 0.05). Delayed gastric emptying was significantly reduced in the ERAS cohort (13.3% vs. 31.7%, p = 0.011). Major complications (Clavien-Dindo ≥ III) occurred in 3.3% vs. 5.8%, readmission rates were 7.0% vs. 6.0%, and 90-day mortality was 3.3% vs. 1.7% in the ERAS and control groups, respectively. Mean length of stay was significantly shorter in the ERAS group (4.48 vs 10.91 days, respectively; p < 0.001), with 81.7% of patients achieving discharge within ≤100 hours compared to none in the control group. Importantly, while the majority of ERAS patients achieved early discharge, a small subset experienced prolonged hospital stay, resulting in partial overlap with the control group. ERAS implementation was the strongest independent predictor of early discharge. CONCLUSION: ERAS pathways in pancreatoduodenectomy are safe and reproducible, and enable substantial acceleration of postoperative recovery without increasing morbidity, supporting their integration into routine pancreatic surgical practice.
背景：增强术后恢复（ERAS）途径越来越多地应用于胃肠道手术；然而，由于对术后发病率和安全性的担忧，它们在胰十二指肠切除术（PD）中的应用仍然存在变数（1-3）。本研究旨在评估ERAS对PD术后预后的影响及超早出院的可行性。方法：进行了一项多中心队列研究，包括180名在四个三级肝胆胰中心接受PD治疗的患者。60名患者在标准化ERAS方案下进行前瞻性管理，而120名在ERAS实施前接受治疗的患者作为对照。分析术后结果，包括胰瘘和胃排空延迟（根据既定标准）。采用多因素logistic回归确定≤100h内出院的预测因素。结果：两组间基线特征具有可比性。ERAS在关键围手术期的依从性超过83%。两组间临床相关胰瘘发生率相似（3.3% vs. 2.5%, p < 0.05）。在ERAS组中，胃排空延迟显著减少（13.3% vs. 31.7%, p = 0.011）。ERAS组和对照组主要并发症（Clavien-Dindo≥III）发生率分别为3.3%和5.8%，再入院率分别为7.0%和6.0%，90天死亡率分别为3.3%和1.7%。ERAS组的平均住院时间显著缩短（分别为4.48天和10.91天；p < 0.001）， 81.7%的患者在≤100小时内出院，而对照组没有。重要的是，虽然大多数ERAS患者提前出院，但一小部分患者住院时间延长，导致与对照组部分重叠。ERAS的实施是早期出院的最强独立预测因子。结论：ERAS在胰十二指肠切除术中的应用是安全的、可重复的，并且能够在不增加发病率的情况下显著加速术后恢复，支持其融入常规胰腺手术实践。试验注册：ClinicalTrials.gov标识符：NCT05192044。
期刊介绍：
Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.
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