ERAS protocols and 'step-up' complication management are associated with improved short-term outcomes following elective total pancreatectomy: a multicenter cohort study.

Authors

Matthäus Felsenstein, Dou Ma, Cao Zhong Jing Jin, Alexandra Zuehlke, Clarissa Schweizer, Karl-Herbert Hillebrandt, Lea Timmermann, Felix Krenzien, Jens Neudecker, Phillip Pfeffer, Frauke V Oberwittler, Rahel Kuhlmann, Kim C Honselmann, Maximillian Coerper, Alexander Semaan, Ramez Wahib, Freya Brodersen, Felix Nickel, Anja K Bardenhorst, Andreas Andreou, Benjamin Struecker, Andreas Pascher, Tobias Keck, Jörg C Kalff, Thilo Hackert, Igor M Sauer, Johann Pratschke, Thomas Malinka

Published in

HPB : the official journal of the International Hepato Pancreato Biliary Association. Sep 05, 2026. Epub Sep 05, 2026.

Abstract

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.
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.
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.
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.

PMID:
42773009
Bibliographic data and abstract were imported from PubMed on 23 Sep 2026.

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