Enhanced Recovery Program After Pancreatectomy

ERAS (enhanced recovery after surgery) was initially developed by Henrik Kehlet in 2001, which was first to describe and implement such a multimodal care protocol successfully in colonic surgery [1]. Subsequently, many studies have been published on this topic, not only in colonic surgery but also in many other fields of surgery (e.g., musculoskeletal [2], breast [3], aortic [4, 5], bariatric [6, 7], and prostate surgery [8]). ERAS has been used with other terms like “fast track” or “critical or clinical pathway.” The purpose of ERAS is not a simple early discharge but with supplying the most appropriate perioperative management by evidence-based medicine, to reduce surgical stress and maintain patient homeostasis therefore to reduce surgical morbidity and hospital stay and cost, and to improve quality of life. With an ERAS program, the patients can reduce the unnecessary stressful routines such as nasogastric tube insertion, preoperative bowel preparation, long perioperative nil by mouth, long prophylactic antibiotics, etc. and can quickly restore the homeostasis with pain control, early ambulation, enhancement of gut function, perioperative nutritional support, psychological support, etc. To maintain ERAS, multidiscipline approach is mandatory including surgeon, physician, anesthesiologist, nurse, dietician, etc.