Complications after duodenopancreatectomy within eras protocols in a developing country

Abstract

Background: Recent studies have suggested that intraoperative fluid overload is associated with the presence of postoperative pancreatic fistula after duodenopancreatectomy. Finding the ideal balance between hypoperfusion and tissue edema with fluids administration during major gastrointestinal surgery is challenging. The aim of this study was to evaluate whether intraoperative fluid management along with enhanced recovery protocols could affect the outcome after a major pancreatic resection. Methods: Data from 67 consecutive patients who underwent duodenopancreatectomy from January 2012 to January 2017 were analyzed. Patients were divided into two groups according to the use of enhanced recovery after surgery protocols. Patients in ERAS protocols had a fluid therapy algorithm which consists: Systolic Volume Variation (SVV) less than 13%, Cardiac Index (CI) higher than 2.5 L/Min/M2 and Delta CO2 less than 6 mmHg. Results: A total of 67 patients were analyzed from July 2012 to January 2017, of these 49.3 % correspond to the female gender. The most frequent diagnosis was Pancreatic Cancer n:48 (71.6%), followed by Intraductal Papillary Mucinous Neoplasm (IPMN) n:6 (9%). The majority of patients were in the ERAS Group with a total of 46 patients (68.7%). In the ERAS group, 80.4% and 95.7% did not develop POPF and Delayed Gastric Emptying (DGE) respectively. The incidence of POFP in all the patients was 11.94% (Grade A are considered biochemical leak and NOT a proper fistula). The incidence of DGE was 11.94%. The probability of intraoperative blood loss less than 300ml was higher in the ERAS group; however, the probability to need a transfusion was lower in the ERAS Group. The probability to use less than 5000ml of fluid therapy was higher in the ERAS group. The total length of stay was statistically significant shorter in the ERAS group. No differences in 30-days mortality were found. Conclusion: The implementation of ERAS protocols in PD did show a decrease in intraoperative blood loss, intravenous fluids therapy, need for transfusion, DGE, and total hospital stay; however, intraoperative fluid restriction in PD did not show to significantly affect POPF.