Implementation of Enhanced Recovery Programme for Pancreatic Resections: Lessons Learnt from Colorectal Surgery

The aim of this thesis was to assess the feasibility, safety and outcomes of ERP for pancreaticoduodenectomy and laparoscopic distal pancreatectomy in a tertiary referral UK university hospital. Specifically for laparoscopic distal pancreatectomy, the aim was also to analyze the impact of laparoscopic surgery and ERP on the cost economics. In Part I, Chapter 2, we evaluated the feasibility and safety of ERP for pancreaticoduodenectomy, at a time when no other evidence was available from the UK. Part II focuses on distal pancreatectomy. In Chapter 3 we assessed the impact of the introduction of the laparoscopic approach for distal pancreatectomy and its impact on outcomes and costs. In Chapter 4 we evaluated whether the implementation of a specific ERP for laparoscopic distal pancreatectomy could have improved further outcomes and costs. Part III, Chapter 5 of this thesis summarises the main finding, discusses where we stand and addresses future prospective. In Part IV the ERPs currently adopted at University Hospital Southampton for pancreaticoduodenectomy and laparoscopic distal pancreatectomy are illustrated.