Application Of ERAS In Surgical Treatment Of Pancreas

Background:Based on evidence-based medical evidence and through multidisciplinary collaboration,enhanced recovery after surgery（ERAS）gradually improves clinical pathways related to perioperative management,which can reduce patients’perioperative stress response,reduce postoperative complications and shorten hospital stay.Thus promoting recovery.This optimized clinical pathway runs through the entire diagnosis and treatment process of surgical patients,and its core is to emphasize the patient-centered treatment concept^[1].ERAS concept was proposed by Henrik Kehlet in 1997,who believed that early postoperative rehabilitation of patients undergoing colorectal surgery could help reduce the incidence of postoperative complications^[2].ERAS interventions involve preoperative patient education,optimal fluid management,multimodal pain control,and the use of evidence-based approaches to reduce postoperative complications^[3-5].Multiple clinical evidence-based medical data show that ERAS program reduces the length of hospital stay and the risk of postoperative complications^[6,7].With the continuous practice of ERAS concept,positive effects have been achieved in the fields of upper digestive tract^[8],hepatobiliary surgery^[9],gynecology^[10]and urology^[11],with some treatment measures even overturning many previous clinical practice experiences.The physiological mechanism of pancreatic diseases is complex,the difficulty of surgical procedures varies greatly,and the incidence of postoperative complications is high.Therefore,pancreatic surgery has always been considered as a high-risk abdominal surgery.With the development of diagnostic techniques,surgical techniques,instruments and intensive care in recent decades,the complications and mortality of pancreatic surgery have been significantly reduced,but still maintained at a high level.pancreaticoduodenectomy（PD）,in particular,still characterized by 30-60%postoperative complications and 1%-10%perioperative mortality^[12].Traditional perioperative management approaches cannot meet the current expectations of patients with pancreatic diseases for high-quality medical services^[13].At present,with the gradual promotion and exploratory application of ERAS concept in pancreatic surgery at home and abroad,certain clinical experience has been accumulated.In 2015,the Professional Committee of Hepatobiliary and Pancreatic Surgery of the Chinese Society of Research Hospitals formulated the first ERAS consensus related to pancreatic surgery in China,namely Expert Consensus on Accelerated Rehabilitation after Hepatobiliary and Pancreatic Surgery（2015 edition）^[14].However,due to the lack of multi-center,randomized prospective studies,the overall trend is still conservative.Objective:To evaluate the safety,efficacy and related measures of accelerated rehabilitation surgery（ERAS）in two major surgical procedures in pancreatic surgery,namely pancreaticoduodenectomy and cocaudectomy.Methods:Clinical data of patients undergoing pancreatic surgery in Department of Hepatobiliary and Pancreatic Surgery,Affiliated Hospital of Yan’an University from February 2017 to August 2022 were retrospectively collected,and data of 83 surgical patients were selected according to inclusion and exclusion criteria.Among them,41patients undergoing perioperative ERAS procedures were assigned as ERAS group（observation group）.Forty-two patients underwent perioperative traditional treatment procedures and were set as the traditional group（control group）.Preoperative general data,intraoperative data,postoperative clinical indicators,postoperative complications and postoperative pain were collected and analyzed.Data collected by SPSS 27.0 statistical analysis software processing,conform to the normal distribution of measurement data:mean(+/-standard deviation（+s）,the independent sample t-test（T）;The measurement data of skewness distribution were measured using the rank sum test（z）.Chi-square test（²）for counting data.P value≥0.05 The original hypothesis was valid,and the difference was not statistically significant.Otherwise,the null hypothesis was rejected and the difference was statistically significant.Results:There was no statistical difference between the two groups in general data analysis and comparison:gender,age,BMI,ALB,ASA grading,TBi L,DBi L,operation method,intraoperative blood loss and operation time（P value≥0.05）.Analysis and comparison of postoperative clinical observation data:the time of first getting out of bed,the time of gastric tube extraction,the number of nausea and vomiting in 3 days after surgery,the time of first anal exhaust,the time of catheter extraction,the time of first bowel movement,the moderate to severe pain in 24 hours after surgery,the moderate to severe pain in 48 hours after surgery,the time of first eating,the number of days in hospital,P<0.05,all of which had statistical differences.Comparison of postoperative complications:postoperative bleeding,biliary fistula,pancreatic fistula,gastric emptie disorder,incision infection,P value≥0.05,there was no statistical difference.Conclusions:There was no difference in the general data of the two groups,including gender,age,BMI,ALB,ASA grading,TBi L,DBi L,and surgical methods.There were no statistically significant differences in surgical methods,intraoperative blood loss,operative time,and postoperative complications between the two groups.Postoperative clinical observation indicators between the two groups,Including the time of first getting out of bed,the time of gastric tube extraction,the number of nausea and vomiting within 3 days after surgery,the time of first anal exhalation,the time of catheter extraction,the time of first bowel movement,the moderate to severe pain at 24 hours after surgery,the moderate to severe pain at 48 hours after surgery,the time of first eating,and the length of hospital stay.ERAS observation group was significantly better than the traditional group,namely the control group.That is,the application of ERAS concept in perioperative pancreatic surgery can promote postoperative recovery of patients,shorten hospital stay and further improve the comfort level of patients during perioperative period without increasing surgical time,intraoperative blood loss and postoperative complications.It is a feasible,effective and safe perioperative intervention measure.