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Enhancing Patient Outcomes After Whipple Procedure

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Pancreaticoduodenectomy, or the Whipple procedure, is one of the most complex abdominal surgeries, and is commonly prescribed as a first line of therapy for cancer located within the pancreatic head. Investigators reported that following a 5-day accelerated recovery pathway after surgery helped to shorten hospital stay and reduce time to eligibility for adjuvant chemotherapy in patients with pancreatic cancer. The findings of a prospective, randomized, controlled study were published by Lavu et al in the Journal of the American College of Surgeons.

“The trial was so successful that we were able to halt the study early and change our standard practice to providing this accelerated postoperative care to all eligible patients,” said Harish Lavu, MD, Associate Professor of Surgery at Jefferson (Philadelphia University and Thomas Jefferson University) and researcher with the Sidney Kimmel Cancer Center–Jefferson Health.

The study analyzed 76 patients undergoing a Whipple operation who had a low to moderate risk for complications. They compared the standard 7-day pathway for recovery and discharge to a pathway that took only 5 days to complete. The 5-day pathway included early discharge planning; a shortened stay in the intensive care unit, modified diet and drain management; rigorous physical therapy with in-hospital gym visits; and follow up via telehealth after discharge.

Major Findings

The 5-day Whipple accelerated recovery pathway (WARP) reduced length of stay without significantly increasing complication rates. Using the WARP protocol, 76% of patients were ready to be discharged at day 5 in the 5-day group, whereas only 13% of the 7-day group were ready to be discharged by day 5.

Perhaps most significantly, reducing recovery time means that patients with pancreatic cancer can transition more quickly to the next phase of treatment. On average, the shorter stay was associated with reducing time to adjuvant therapy by 15 days (51 days with 5-day recovery vs 66 days with 7-day recovery).

“Our accelerated recovery pathway incorporates the latest in recovery science by ensuring patients get mobile shortly after surgery, which has been shown to improve outcomes,” said study authors in a statement. “We also assign experienced recovery nurse practitioners to follow-up care via telehealth, which has been shown to reduce unnecessary hospital readmissions. The results of this study validate much of what the field is beginning to view as best practice and it’s exciting to be able to define a more effective pathway to better care for patients.”

Disclosure: This trial was supported by the Sidney Kimmel Cancer Center Support Grant 5P30CA056036-17 and the Biostatistics Shared Resource. The study authors' full disclosures can be found at journalacs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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