Published online Jul 28, 2016. doi: 10.3748/wjg.v22.i28.6456
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
Processing time: 114 Days and 0.3 Hours
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.
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.