A Modified Fast-track Program for Pancreatic Surgery: a Prospective Single-center Experience

Overview

Journal Langenbecks Arch Surg

Specialty General Surgery

Date 2010 Aug 13

PMID 20703500

Citations 28

Authors

Pierluigi Di Sebastiano

Leonardina Festa

Antonio De Bonis

Andrea Ciuffreda

Maria Rosa Valvano

Angelo Andriulli

F Francesco di Mola

Affiliations

Soon will be listed here.

Abstract

Objective: The objective of this study is to evaluate the impact of a fast-track protocol in a high-volume center for patients with pancreatic disorders.

Background: The concept of fast-track surgery allowing accelerated postoperative recovery is accepted in colorectal surgery, but efficacy data are only preliminary for patients undergoing major pancreatic surgery. We aimed to evaluate the impact of a modified fast-track protocol in a high-volume center for patients with pancreatic disorders.

Methods: Between February 2005 and January 2010, 145 subjects had resective pancreatic surgery and were enrolled in the program. Essential features of the program were no preanaesthetic medication, upper and lower air-warming device, avoidance of excessive i.v. fluids perioperatively, effective control of pain, early reinstitution of oral feeding, and immediate mobilization and restoration of bowel function following surgery. Outcome measures were postoperative complications such as pancreatic fistula, delayed gastric emptying, biliary leak, intra-abdominal abscess, post-pancreatectomy hemorrhage, acute pancreatitis, wound infection, 30-day mortality, postoperative hospital stay, and readmission rates.

Results: On average, patients were discharged on postoperative day 10 (range 6-69), with a 30-day readmission rate of 6.2%. Percentage of patients with at least one complication was 38.6%. Pancreatic anastomotic leakage occurred in seven of 101 pancreatico-jejunostomies, and biliary leak in three of 109 biliary jejunostomies. Postoperative hemorrhage occurred in ten (6.9%) patients and wound infection in nine (6.2%) cases. In-hospital mortality was 2.7%. Fast-track parameters, such as normal food and first stool, correlated significantly with early discharge (<0.05). At multivariate analysis, lack of jaundice, and resumption of normal diet by the 5th postoperative day were independent factors of early discharge.

Conclusion: Fast-track programs are feasible, easy, and also applicable for patients undergoing a major surgery such as pancreatic resection.

Citing Articles

Blood Serum and Drainage Microbial and Mitochondrial Metabolites in Patients after Surgery for Pancreatic Cancer.

Getsina M, Tsyba N, Polyakov P, Beloborodova N, Chernevskaya E Metabolites. 2023; 13(12).

PMID: 38132880 PMC: 10744670. DOI: 10.3390/metabo13121198.

Laparoscopic Versus Open Hartmann Reversal: A Case-Control Study.

Panaccio P, Grottola T, Percario R, Selvaggi F, Cericola S, Lapergola A Surg Res Pract. 2021; 2021:4547537.

PMID: 33553574 PMC: 7847322. DOI: 10.1155/2021/4547537.

Improved Outcomes in 394 Pancreatic Cancer Resections: the Impact of Enhanced Recovery Pathway.

Agarwal V, Thomas M, Joshi R, Chaudhari V, Bhandare M, Mitra A J Gastrointest Surg. 2018; 22(10):1732-1742.

PMID: 29777454 DOI: 10.1007/s11605-018-3809-7.

Safety of total gastrectomy without nasogastric and nutritional intubation.

Zhang H, Sun L, Yang X, Feng F, Li G Mol Clin Oncol. 2017; 7(3):421-426.

PMID: 28894580 PMC: 5582511. DOI: 10.3892/mco.2017.1331.

Academic Pancreas Centers of Excellence: Guidance from a multidisciplinary chronic pancreatitis working group at PancreasFest.

Sheth S, Conwell D, Whitcomb D, Alsante M, Anderson M, Barkin J Pancreatology. 2017; 17(3):419-430.

PMID: 28268158 PMC: 5525332. DOI: 10.1016/j.pan.2017.02.015.

References

Minowada G, Welch W . Clinical implications of the stress response. J Clin Invest. 1995; 95(1):3-12. PMC: 295356. DOI: 10.1172/JCI117655. View

Andersen H, Lewis S, Thomas S . Early enteral nutrition within 24h of colorectal surgery versus later commencement of feeding for postoperative complications. Cochrane Database Syst Rev. 2006; (4):CD004080. DOI: 10.1002/14651858.CD004080.pub2. View

Karliczek A, Jesus E, Matos D, Castro A, Atallah A, Wiggers T . Drainage or nondrainage in elective colorectal anastomosis: a systematic review and meta-analysis. Colorectal Dis. 2006; 8(4):259-65. DOI: 10.1111/j.1463-1318.2006.00999.x. View

Cheatham M, Chapman W, Key S, SAWYERS J . A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy. Ann Surg. 1995; 221(5):469-76; discussion 476-8. PMC: 1234620. DOI: 10.1097/00000658-199505000-00004. View

Buchler M, Wagner M, Schmied B, Uhl W, Friess H, Zgraggen K . Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg. 2003; 138(12):1310-4. DOI: 10.1001/archsurg.138.12.1310. View

Berberat P, INGOLD H, Gulbinas A, Kleeff J, Muller M, Gutt C . Fast track--different implications in pancreatic surgery. J Gastrointest Surg. 2007; 11(7):880-7. DOI: 10.1007/s11605-007-0167-2. View

Hill G, Douglas R, Schroeder D . Metabolic basis for the management of patients undergoing major surgery. World J Surg. 1993; 17(2):146-53. DOI: 10.1007/BF01658920. View

Neoptolemos J, Russell R, Bramhall S, Theis B . Low mortality following resection for pancreatic and periampullary tumours in 1026 patients: UK survey of specialist pancreatic units. UK Pancreatic Cancer Group. Br J Surg. 1997; 84(10):1370-6. View

Wente M, Veit J, Bassi C, Dervenis C, Fingerhut A, Gouma D . Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007; 142(1):20-5. DOI: 10.1016/j.surg.2007.02.001. View

10.

Fearon K, Ljungqvist O, von Meyenfeldt M, Revhaug A, Dejong C, Lassen K . Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005; 24(3):466-77. DOI: 10.1016/j.clnu.2005.02.002. View

11.

Yeo C, Cameron J, Sohn T, Lillemoe K, Pitt H, Talamini M . Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997; 226(3):248-57; discussion 257-60. PMC: 1191017. DOI: 10.1097/00000658-199709000-00004. View

12.

Kehlet H, Dahl J . Anaesthesia, surgery, and challenges in postoperative recovery. Lancet. 2003; 362(9399):1921-8. DOI: 10.1016/S0140-6736(03)14966-5. View

13.

Wente M, Bassi C, Dervenis C, Fingerhut A, Gouma D, Izbicki J . Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007; 142(5):761-8. DOI: 10.1016/j.surg.2007.05.005. View

14.

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J . Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005; 138(1):8-13. DOI: 10.1016/j.surg.2005.05.001. View

15.

Balzano G, Zerbi A, Braga M, Rocchetti S, Beneduce A, Di Carlo V . Fast-track recovery programme after pancreatico- duodenectomy reduces delayed gastric emptying. Br J Surg. 2008; 95(11):1387-93. DOI: 10.1002/bjs.6324. View

16.

Balcom 4th J, Rattner D, Warshaw A, Chang Y, Fernandez-Del Castillo C . Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg. 2001; 136(4):391-8. DOI: 10.1001/archsurg.136.4.391. View

17.

Muller M, Friess H, Beger H, Kleeff J, Lauterburg B, Glasbrenner B . Gastric emptying following pylorus-preserving Whipple and duodenum-preserving pancreatic head resection in patients with chronic pancreatitis. Am J Surg. 1997; 173(4):257-63. DOI: 10.1016/S0002-9610(96)00402-3. View

18.

Gouma D, van Geenen R, van Gulik T, de Haan R, de Wit L, Busch O . Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg. 2000; 232(6):786-95. PMC: 1421271. DOI: 10.1097/00000658-200012000-00007. View

19.

Kehlet H . Fast-track colorectal surgery. Lancet. 2008; 371(9615):791-3. DOI: 10.1016/S0140-6736(08)60357-8. View

20.

Kehlet H, Wilmore D . Multimodal strategies to improve surgical outcome. Am J Surg. 2002; 183(6):630-41. DOI: 10.1016/s0002-9610(02)00866-8. View