P-0121 - Principles of “Fast-track surgery” for pancreticoduodenectomy

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Pancreatic Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Ighor Shchepotin
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors V. Primak
  • National Cancer Institute, Kyiv/UA

Abstract

Introduction

Despite recent improvement pancreatic surgery is still associated with significant morbidity and mortality. Multi-modal “fast-track” pathways have recently been introduced, aiming to expedite patient recovery. The objective of this study is to evaluate the impact of a fast-track protocol after pancreaticoduodenectomy (PD).

Methods

Between March 2008 and January 2014, 87 subjects had resective pancreatic surgery and were enrolled in the program. Essential features of the program were no preanaesthetic medication, patients warming, avoidance of excessive i.v. fluids perioperatively, transverse and small abdominal incisions, no tubes, 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, postoperative hemorrhage, acute pancreatitis, wound infection, 30-day mortality, postoperative hospital stay, and readmission rates.

Results

The rates of pancreatic fistula were 35,6%. On average, patients were discharged on postoperative day 11 (range 8–51), with a 30-day readmission rate of 9.1%. Delayed gastric emptying occurred in 36,7% and biliary leak in 6,9% of cases. Postoperative hemorrhage occurred in three (3.4%) patients and wound infection in five (5.7%) cases. In-hospital mortality was 3.4%. At multivariate analysis, body mass index, lack of jaundice and absence of concomitant diabetes were independent factors of early discharge.

Conclusion

Patients undergoing fast-track rehabilitation suffer from less pain and have an earlier discharge. Fast-track programs are feasible, easy, and also applicable for patients undergoing a major surgery such as pancreaticresection.