Experiencia de un programa de fast-track en la duodenopancreatectomía cefálica / Experience of a cephalic pancreatoduodenectomy fast-track program

Introducción La Fast-track surgery se ha planteado recientemente como un programa eficaz en la cirugía pancreática. Aunque la morbimortalidad tras la duodenopancreatectomía cefálica ha mejorado en la última década, la prevalencia de complicaciones postoperatorias continúa siendo elevada. El objetivo de este trabajo es examinar los resultados de un programa de Fast-track en este tipo de intervenciones. Resultados Ochenta y dos pacientes fueron intervenidos de duodenopancreatectomía cefálica dentro de un protocolo de recuperación precoz. La mediana de edad fue 63 años. El 65% fueron varones. La mediana de estancia hospitalaria fue de 9 días, con un 14,6% de reingresos. Se aplicó la clasificación de Clavien-DeOliveira para evaluar la severidad de las complicaciones. La morbilidad global fue del 47,6%. La complicación más frecuente correspondió al grupo que englobaba las generales, seguidas por la infección de la herida quirúrgica y complicaciones cardiorrespiratorias. Teniendo en cuenta que solo el 32% de los pacientes tuvieron drenaje desde la cirugía, la frecuencia de fístula pancreática fue del 8,5%, y esta se situaba en los grupos de mayor morbilidad (grados III, IV y V). La mortalidad postoperatoria fue del 4,9%. La cirugía asociada constituyó un factor de riesgo para la mortalidad. Conclusiones La Fast-track surgery en la duodenopacreatectomía cefálica realizada en centros de alto volumen es un programa seguro y eficaz que permite además mejorar los resultados de morbimortalidad (AU)

Introduction Fast-track surgery has been proposed as a valid method in pancreatic surgery. Although morbidity and mortality has improved in the last decade, the prevalence of postoperative complications is still high. The aim of this study is to analyse the results of a programme of Fast-track surgery in this context. Results A total of 82 patients who underwent a cephalic pancreatoduodenectomy with a programme of early recovery after surgery, were analysed. There were 53 men, with a median age of 63 years old. The median hospital stay was 9 days, with 14.6% of readmissions. The Clavien-DeOliveira Classification was applied to evaluate the severity of postoperative complications. The overall morbidity was 47.6%. The most common complications were general, followed by infection of surgical wound and cardiopulmonary events. Taking into account that a surgical drain was used in 32% of patients, the prevalence of pancreatic fistula was 8.5%, and were classified in the most severity grades (III, IV and V). The postoperative mortality was 4.9%. The associated surgery was a risk factor of mortality. Conclusions The Fast-track programme after pancreatoduodenectomy in high volume centres is a safe and effective method, that can improve the morbidty and mortality results (AU)

[Experience of a cephalic pancreatoduodenectomy fast-track program]. / Experiencia de un programa de fast-track en la duodenopancreatectomía cefálica.

INTRODUCTION: Fast-track surgery has been proposed as a valid method in pancreatic surgery. Although morbidity and mortality has improved in the last decade, the prevalence of postoperative complications is still high. The aim of this study is to analyse the results of a programme of Fast-track surgery in this context. RESULTS: A total of 82 patients who underwent a cephalic pancreatoduodenectomy with a programme of early recovery after surgery, were analysed. There were 53 men, with a median age of 63 years old. The median hospital stay was 9 days, with 14.6% of readmissions. The Clavien-DeOliveira Classification was applied to evaluate the severity of postoperative complications. The overall morbidity was 47.6%. The most common complications were general, followed by infection of surgical wound and cardiopulmonary events. Taking into account that a surgical drain was used in 32% of patients, the prevalence of pancreatic fistula was 8.5%, and were classified in the most severity grades (III, IV and V). The postoperative mortality was 4.9%. The associated surgery was a risk factor of mortality. CONCLUSIONS: The Fast-track programme after pancreatoduodenectomy in high volume centres is a safe and effective method, that can improve the morbidty and mortality results.