ERAS protocols and 'step-up' complication management are associated with improved short-term outcomes following elective total pancreatectomy: a multicenter cohort study
In brief
Enhanced recovery and step-up strategy cuts major complications by half after total pancreatectomy
In a multicenter review of 429 elective total pancreatectomies, patients treated under combined ERAS protocols and step-up complication management experienced major complications in 19.7% of cases versus 41.4% before these measures, and their hospital stay fell from 26 to 18 days. Mortality trended lower but did not reach statistical significance, suggesting that wider adoption of these coordinated peri-operative pathways could improve safety while further research confirms survival benefits.
- Journal
- HPB : the official journal of the International Hepato Pancreato Biliary Association (Q1)
- Published
- 5 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Matthäus Felsenstein, Dou Ma, Cao Zhong Jing Jin, Alexandra Zuehlke, Clarissa Schweizer, Karl-Herbert Hillebrandt, et al.
- PMID
- 42773009
- DOI
- 10.1016/j.hpb.2026.08.2005
Why clinicians should know about it
- Picked for Gastrointestinal and Colorectal Surgery (paper of the day, 23 September 2026): ERAS + step‑up improves outcomes after total pancreatectomy
Abstract
BACKGROUND: Total pancreatectomy remains associated with substantial morbidity and mortality, largely driven by postoperative complications and failure-to-rescue. ERAS and 'step-up' strategies are each associated with improved outcomes after pancreatic surgery, yet their combined effect following total pancreatectomy remains poorly defined. METHODS: This retrospective multicenter cohort study analyzed 429 patients undergoing elective PPTP. The reference cohort from Charité University Hospital (n=236, 2014-2023) was stratified into pre-ERAS and ERAS trial periods, the latter coinciding with 'step-up' complication management procedures (2019-2023). Institutional data were prospectively recorded via the EIAS and benchmarked against national ERAS (n=80) and non-ERAS centers (n=113). Adjusted multivariable Cox regression and Kaplan-Meier analyses assessed survival and recovery. RESULTS: The combined ERAS care era was associated with significantly shorter length of stay (17.9d|25.6d; p<0.001), fewer major complications (19.7%|41.4%; p<0.001) and a non-significant 30d mortality reduction (2.2%|7.1%; p=0.09), confirmed also via adjusted regression analyses. Mean interventions per patient decreased by 52.9% (p=0.01) with a shift from surgical to interventional treatments (p=0.005). High ERAS adherence (≥80%) correlated with earlier ICU and hospital discharge. CONCLUSIONS: Combined ERAS and 'step-up' management was associated with improved safety and recovery after PPTP supporting broader implementation of standardized multidisciplinary perioperative care after total pancreatectomy.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.