Enhanced recovery after pancreatic surgery: a systematic review

Background: Enhanced recovery after surgery (ERAS) program is widely used because its advantage in reducing the length of hospital stay (LOS) and morbidity rate. Patients have suffered great benefits in colonic surgery, gastric cancer surgery and liver surgery. But in pancreatic surgery, the efficacy of ERAS program remains controversial. This study aimed to gain a current, comprehensive picture of ERAS program compares with conventional care in patients undergoing pancreatic surgery. Methods: MEDLINE, EMBASE, the Cochrane Library, and the Chinese National Knowledge Infrastructure database were searched until October 2015. Risk ratios (RRs), standard mean difference (SMD) and 95% confidence intervals (CIs) were calculated. Results: The analysis included 16 studies (5 were with single cohort, and another 11 were with 2 groups). Patients in ERAS group had significantly lower morbidity (RR=0.77, 95% CI=0.70-0.84) and shorter LOS (SWD=-0.61, 95% CI=-0.94-0.26). Moreover, ERAS program would not increase mortality rates (RR=0.90, 95% CI=0.49-1.64) and readmission rates (RR=0.92, 95% CI=0.71=1.18). Nevertheless, ERAS program also helped reducing pancreatic fistula (RR=0.77, 95% CI=0.70-0.84) and digestive gastric empty rates (RR=0.66, 95% CI=0.53-0.83). Conclusion: ERAS program is safe and efficient for patients undergoing pancreatic surgery.