Abstract: Objective:To investigate the application value of enhanced recovery after surgery(ERAS) in laparoscopic pancreaticoduodenectomy (LPD).
Methods:The retrospective cohort study was adopted. The clinical data of 64 patients who underwent LPD from January 2014 to January 2016 in the Shangjin Hospital of West China Hospital of Sichuan University were collected. Of the 64 patients, 41 patients managed with ERAS program between March 2015 and January 2016 were allocated into the ERAS group, 23 patients managed with traditional perioperative treatment between January 2014 and Febuary 2015 were allocated into the traditional group. The following indexes were observed: (1) intraoperative status: operation time, volume of intraoperative blood loss, conversion to open surgery, pylorus preservation. (2) Postoperative status: the time to outofbed activity, time to postoperative flatus, time of drainage tube removal, postoperative complications (pancreaticleakage, bile leakage, hemorrhage, delayed gastric emptying, abdominal infection, cardiovascular complications), duration of postoperative hospital stay, death within the postoperative 30 days. (3) Followup status: incidence of complications after discharge and survival of patients. The followup including incidence of complications after discharge and survival of patients was conducted by outpatient examination and telephone interview up to March 2016. Measurement data with normal distribution were presented as ±s and analyzed by t test. Count data were analyzed using the chisquare test or Fisher exact probability.
Results:(1) Intraoperative status: the operation time, volume of intraoperative blood loss, number of patients with conversion to open surgery and pylorus preservation were (377±38)minutes, (164±48)mL, 1, 40 in the ERAS group and (392±53)minutes, (152±31)mL, 2, 21 in the traditional group, showing no statistically significant difference between the 2 groups (t= 5.02, 8.43, χ²=1.29, 1.29, P>0.05). (2) Postoperative status: the time to outofbed activity,time to postoperative flatus, time of drainage tube removal and duration of postoperative hospital stay were (1.7±0.6)days, (2.5±0.6)days, (5.3±1.7)days, (9.1±1.3)days in the ERAS group and (2.1±0.9)days, (3.8±1.2)days, (8.2±2.6)days, (11.9±1.8)days in the traditional group, showing statistically significant differences between the 2 groups( t =-5.28, -7.01,-16.20, -10.67, P<0.05). The numbers of patients with pancreatic leakage in stage A, B and C, bile leakage, hemorrhage, delayed gastric emptying, abdominal inflection, cardiovascular complications and death in the postoperative 30 days were 8, 0, 0, 0, 1, 3, 0, 1, 1 in the ERAS group and 5, 1, 0, 1, 1, 3, 2, 1, 0 in the traditional group, respectively, showing no significant difference between the 2 groups (χ²=0.37, 1.81, 0.18, 0.57, 3.68, 0.18, P>0.05). (3) Followup status: the 64 patients were followed up for a median time of 11 months (range, 1-25 months). During the followup, number of patients complicated with diabetes, local tumor recurrence, liver metastasis and death were 5, 4, 1, 0 in the ERAS group and 2, 5, 2, 3(2 died of tumor recurrence and 1 died of myocardial infarction) in the traditonal group.
Conclusion:Application of ERAS in the perioperative management of LPD is safe and effective, meanwhile, it can accelerate the recovery of patients who underwent LPD and shorten the duration of hospital stay.