Individualized enhanced recovery after pancreaticoduodenectomy surgical pathways management: Key variables and optimization strategies

Table 1 Key variables influencing individualized enhanced recovery after surgery in pancreaticoduodenectomy

Category	Key variables
Patient-level factors	Age, ASA classification, nutritional status, sarcopenia, obesity, diabetes, cardiopulmonary disease, liver/renal dysfunction, obstructive jaundice, psychological state, compliance
Disease-and surgery-level factors	Etiology (benign/malignant), tumor stage, jaundice severity, surgical approach (open/Laparoscopic/robotic), pancreatic texture, pancreatic duct diameter, FRS, operation time, blood loss
Perioperative intervention-level factors	Analgesia strategy, antiemetic regimen, nutritional support, catheter/drainage management, early mobilization, complication monitoring intensity

ASA: American Society of Anesthesiologists; FRS: Fistula Risk Score.

Table 2 Perioperative individualized enhanced recovery after surgery optimization strategies for pancreaticoduodenectomy

Perioperative stage	Individualized management strategies
Preoperative	Comprehensive risk stratification; targeted nutritional intervention; selective preoperative biliary drainage (TB ≥ 250 μmol/L); comorbidity optimization; MDT evaluation; personalized education
Intraoperative	Goal-directed fluid therapy; intraoperative warming; personalized anastomosis; locally calibrated FRS-guided drainage placement
Postoperative	Risk-stratified multimodal analgesia; graded enteral/oral feeding; progressive early mobilization; risk-adjusted catheter removal; stratified complication monitoring

TB: Total bilirubin; MDT: Multi-disciplinary team; FRS: Fistula Risk Score.