Enhanced recovery after surgery for pancreaticoduodenectomy: Review of current evidence and trends

Pancreaticoduodenectomy (PD) remains a morbid procedure. The use of Enhanced Recovery After Surgery (ERAS) pathways has proven to reduce care time and post-operative complications after colorectal surgery. There is a high potential for reducing morbidity associated with PD by utilizing ERAS. Guidelines for perioperative care after PD were published in 2013, but these recommendations could even change in one year. The purpose of this review is to examine the current evidence for ERAS in preoperative, intraoperative and postoperative setting of care for PD patients and to propose ERAS evidence-based protocol for patients undergoing PD. Evidence indicates that ERAS protocols may be implemented in PD without compromising patient safety or increasing length of stay. ERAS in the context of PD should be standardized based on the best available evidence, and ERAS programmes involving multiple centers should be performed.