Title : Enhanced Recovery After Surgery (ERAS) versus conventional care in pancreaticoduodenodenectomy for pancreatic cancer: A systematic review and meta analysis of randomized controlled trials
Abstract:
Background: Pancreaticoduodenectomy is associated with substantial postoperative morbidity and delays in recovery that can hinder timely initiation of adjuvant therapy. Enhanced Recovery After Surgery (ERAS) pathways aim to attenuate surgical stress and accelerate functional recovery, but their effectiveness and safety in pancreaticoduodenectomy remain incompletely defined. This systematic review and meta-analysis evaluated randomized controlled trials comparing ERAS with conventional postoperative care.
Methods: A systematic search of PubMed, Embase, and CENTRAL was performed through November 2025. Randomized controlled trials enrolling adults undergoing pancreaticoduodenectomy and comparing ERAS or accelerated recovery pathways with standard care were included. Primary outcomes were length of stay and overall postoperative complications. Secondary outcomes included clinically relevant postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), readmission, mortality, and time to adjuvant therapy. Fixed-effects models were used for meta-analysis.
Results: Six randomized trials (n = 638) met inclusion criteria. ERAS significantly reduced postoperative length of stay (mean difference −4.7 days; 95% CI −7.2 to −2.3) and overall complications (odds ratio 0.63; 95% CI 0.44–0.91), with low heterogeneity. ERAS halved the risk of delayed gastric emptying (odds ratio 0.54; 95% CI 0.31–0.94) and did not increase clinically relevant POPF, readmissions, or mortality. Three trials reported adjuvant therapy timing, all demonstrating earlier initiation after ERAS (8–15 days sooner).
Conclusions: Across six randomized trials, ERAS pathways after pancreaticoduodenectomy improved postoperative recovery, reduced morbidity, and facilitated earlier initiation of adjuvant therapy without compromising safety. These findings support ERAS as the preferred perioperative care strategy for pancreaticoduodenectomy.
