Safety and efficacy of Enhanced Recovery after Surgery (ERAS) in pancreaticoduodenectomy combined with vascular reconstruction.

OBJECTIVE

To investigate the safety and clinical efficacy of the Enhanced Recovery After Surgery (ERAS) protocol specifically in patients undergoing pancreaticoduodenectomy (PD) combined with vascular reconstruction.

PATIENTS AND

METHODS

A retrospective analysis was conducted on 47 patients who underwent PD with vascular reconstruction (including portal vein and superior mesenteric vein resection) between 2015 and 2024. Patients were divided into the ERAS cohort (n = 20) and the pre-ERAS control cohort (n = 27). We focused on markers of organ congestion recovery, inflammatory stress response, and specialized postoperative complications.

RESULTS

The ERAS protocol was successfully implemented without increasing the incidence of major postoperative complications (such as pancreatic fistula, hemorrhage, or biliary leakage) or 30-day readmission rates. Notably, the incidence of delayed gastric emptying (DGE) was significantly lower in the ERAS group compared to the control group (5% vs. 33.3%, P < 0.05). The ERAS cohort demonstrated a significantly shorter postoperative hospital stay [17.5 (16.9,18.6) days vs. 20.4 (19.4,21.5) days, P < 0.001] and reduced medical expenses. Biochemically, the ERAS group showed a more rapid normalization of NLR and a higher maintenance of PNI during the first postoperative week (P < 0.05), reflecting mitigated inflammatory response and better-preserved immune-nutritional reserves.

CONCLUSIONS

Implementation of the ERAS protocol in PD with vascular reconstruction is safe and feasible, showing preliminary evidence in mitigating surgical stress and accelerating hepatic and gastrointestinal functional recovery. The ERAS cohort experienced a significant reduction in DGE and shorter hospital stays without increasing postoperative complications. These findings support ERAS as a standardized perioperative framework even for PD with vascular reconstruction.