Is ERAS effective and safe in laparoscopic gastrectomy for gastric carcinoma? A meta-analysis

Ming-Zhe Li, Wen-Hui Wu, Liang Li, Xue-Fu Zhou, Heng-Liang Zhu, Jian-Feng Li, Yu-Long He, Ming-Zhe Li, Wen-Hui Wu, Liang Li, Xue-Fu Zhou, Heng-Liang Zhu, Jian-Feng Li, Yu-Long He

Abstract

Background: It is still unclear whether enhanced recovery after surgery is effective and safe in laparoscopic gastrectomy for gastric carcinoma.

Methods: Cochrane library databases, Medline, Embase, and Pubmed were searched from January 1, 1986, to December 31, 2016. Randomized controlled trials (RCTs) comparing fast-track recovery with conventional recovery strategies in laparoscopic radical gastrectomy for gastric carcinoma were included. The main outcomes measured were postoperative hospital stay, time to first flatus, hospital charge, and overall complication rate.

Results: Six RCTs with 400 patients were included in this study. Fast-track surgery has shorter postoperative hospital stays (weighted mean difference (WMD) - 2.65; 95% CI, - 4.01 to - 1.29, z = 3.82, P < 0.01) and less hospitalization expenditure (WMD - 523.43; 95% CI, - 799.79 to - 247.06, z = 3.71, P < 0.01) than conventional recovery strategies. There was no significant difference with respect to duration to first flatus (WMD - 17.72; 95% CI, - 39.46-4.02, z = 1.60, P = 0.11) and complication rate (OR 1.57; 95% CI, 0.82-2.98, z = 1.37, P = 0.17).

Conclusions: Enhanced recovery after surgery is effective and safe and is thus recommended in laparoscopic radical gastrectomy for gastric carcinoma.

Keywords: Fast-track surgery; Gastric carcinoma; Laparoscopic; Meta-analysis.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the ethic committee of the Seventh Affiliated Hospital of Sun Yat-sen University.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Article selection flow chart
Fig. 2
Fig. 2
Funnel plot showing no significant publication bias
Fig. 3
Fig. 3
Forest plot describing postoperative hospital stay between FTS and conventional recovery strategies in laparoscopic gastrectomy for gastric cancer. FTS fast-track surgery
Fig. 4
Fig. 4
Forest plot describing duration to first flatus after surgery between FTS and conventional recovery strategies in laparoscopic gastrectomy for gastric cancer. FTS fast-track surgery
Fig. 5
Fig. 5
Forest plot describing hospital charge between FTS and conventional recovery strategies in laparoscopic gastrectomy for gastric cancer. FTS fast-track surgery
Fig. 6
Fig. 6
Forest plot describing complication rate between FTS and conventional recovery strategies in laparoscopic gastrectomy for gastric cancer. FTS fast-track surgery

References

    1. Price TJ, Shapiro JD, Segelov E, Karapetis CS, Pavlakis N, Van Cutsem E, et al. Management of advanced gastric cancer. Expert Rev Gastroenterol Hepatol. 2012;6:199–208. doi: 10.1586/egh.11.103.
    1. Jeong SH, Lee YJ, Park ST, Choi SK, Hong SC, Jung EJ, et al. Risk of recurrence after laparoscopy-assisted radical gastrectomy for gastric cancer performed by a single surgeon. Surg Endosc. 2011;25:872–878. doi: 10.1007/s00464-010-1286-5.
    1. Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008;248:721–727. doi: 10.1097/SLA.0b013e318185e62e.
    1. Adachi Y, Suematsu T, Shiraishi N, Katsuta T, Morimoto A, Kitano S, et al. Quality of life after laparoscopy-assisted Billroth I gastrectomy. Ann Surg. 1999;229:49–54. doi: 10.1097/00000658-199901000-00006.
    1. Bardram L, Funch-Jensen P, Jensen P, Crawford ME, Kehlet H. Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilisation. Lancet. 1995;345:763–764. doi: 10.1016/S0140-6736(95)90643-6.
    1. D’Hondt M, Vanneste S, Pottel H, Devriendt D, Van Rooy F, Vansteenkiste F. Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss. Surg Endosc. 2011;25:2498–2504. doi: 10.1007/s00464-011-1572-x.
    1. Liu XX, Jiang ZW, Wang ZM, Li JS. Multimodal optimization of surgical care shows beneficial outcome in gastrectomy surgery. J Parenter Enter Nutr. 2010;34:313–321. doi: 10.1177/0148607110362583.
    1. Zouros E, Liakakos T, Machairas A, Patapis P, Agalianos C, Dervenis C. Improvement of gastric emptying by enhanced recovery after pancreaticoduodenectomy. Hepatobiliary Pancreat Dis Int. 2016;15:198–208. doi: 10.1016/S1499-3872(16)60061-9.
    1. Wang D, Kong Y, Zhong B, Zhou X, Zhou Y. Fast-track surgery improves postoperative recovery in patients with gastric cancer: a randomized comparison with conventional postoperative care. J Gastrointest Surg. 2010;14:620–627. doi: 10.1007/s11605-009-1139-5.
    1. Feng F, Ji G, Li JP, Li XH, Shi H, Zhao ZW, et al. Fast-track surgery could improve postoperative recovery in radical total gastrectomy patients. World J Gastroenterol. 2013;19:3642–3648. doi: 10.3748/wjg.v19.i23.3642.
    1. Yamada T, Hayashi T, Cho H, Yoshikawa T, Taniguchi H, Fukushima R, et al. Usefulness of enhanced recovery after surgery protocol as compared with conventional perioperative care in gastric surgery. Gastric Cancer. 2012;15:34–41. doi: 10.1007/s10120-011-0057-x.
    1. Liu XX, Pan HF, Jiang ZW, Zhang S, Wang ZM, Chen P, et al. “Fast-track” and “minimally invasive” surgery for gastric cancer. Chin Med J. 2016;129:2294–2300. doi: 10.4103/0366-6999.190659.
    1. Hu JC, Jiang LX, Cai L, Zheng HT, Hu SY, Chen HB, et al. Preliminary experience of fast-track surgery combined with laparoscopy-assisted radical distal gastrectomy for gastric cancer. J Gastrointest Surg. 2012;16:1830–1839. doi: 10.1007/s11605-012-1969-4.
    1. Kim JW, Kim WS, Cheong JH, Hyung WJ, Choi SH, Noh SH. Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer: a randomized clinical trial. World J Surg. 2012;36:2879–2887. doi: 10.1007/s00268-012-1741-7.
    1. Abdikarim I, Cao XY, Li SZ, Zhao YQ, Taupyk Y, Wang Q. Enhanced recovery after surgery with laparoscopic radical gastrectomy for stomach carcinomas. World J Gastroenterol. 2015;21:13339–13344. doi: 10.3748/wjg.v21.i47.13339.
    1. Liu G, Jian F, Wang X, Chen L. Fast-track surgery protocol in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer: a randomized controlled trial. Onco Targets Ther. 2016;9:3345–3351.
    1. Fang F, Gao J, Bi X, Han F, Wang HJ. Effect and clinical significance of fast-track surgery combined with laparoscopic radical gastrectomy on the plasma level of vascular endothelial growth factor in gastric antrum cancer. Spring. 2016;5:50. doi: 10.1186/s40064-016-1699-2.
    1. Xia M, Zhang L, Tang Z, Zhao Y, Wang Q. Laparoscopic radical gastrectomy for resectable advanced gastric cancer within enhanced recovery programs: a prospective randomized controlled trial. J Laparoendosc Adv Surg Tech A. 2016. PMID: 27875094; 10.1089/lap.2016.0057.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8:336–341. doi: 10.1016/j.ijsu.2010.02.007.
    1. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1–12. doi: 10.1016/0197-2456(95)00134-4.
    1. Bu J, Li N, Huang X, He S, Wen J, Wu X. Feasibility of fast-track surgery in elderly patients with gastric cancer. J Gastrointest Surg. 2015;19:1391–1398. doi: 10.1007/s11605-015-2839-7.
    1. Li YJ, Huo TT, Xing J, An JZ, Han ZY, Liu XN, et al. Meta-analysis of efficacy and safety of fast-track surgery in gastrectomy for gastric cancer. World J Surg. 2014;38(12):3142–3151. doi: 10.1007/s00268-014-2690-0.
    1. Yu Z, Zhuang CL, Ye XZ, Zhang CJ, Dong QT, Chen BC. Fast-track surgery in gastrectomy for gastric cancer: a systematic review and meta-analysis. Langenbeck's Arch Surg. 2014;399(1):85–92. doi: 10.1007/s00423-013-1148-4.
    1. Nishiguchi K, Okuda J, Toyoda M, Tanaka K, Tanigawa N. Comparative evaluation of surgical stress of laparoscopic and open surgeries for colorectal carcinoma. Dis Colon Rectum. 2001;44:223–230. doi: 10.1007/BF02234297.
    1. Yu G, Tang B, PW Y, Peng ZH, Qian F, Sun G. Systemic and peritoneal inflammatory response after laparoscopic-assisted gastrectomy and the effect of inflammatory cytokines on adhesion of gastric cancer cells to peritoneal mesothelial cells. Surg Endosc. 2010;24:2860–2870. doi: 10.1007/s00464-010-1067-1.
    1. Lee JH, Yom CK, Han HS. Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer. Surg Endosc. 2009;23:1759–1763. doi: 10.1007/s00464-008-0198-0.
    1. Etoh T, Shiraishi N, Kitano S. Laparoscopic gastrectomy for cancer. Dig Dis. 2005;23:113–118. doi: 10.1159/000088592.
    1. Grantcharov TP, Kehlet H. Laparoscopic gastric surgery in an enhanced recovery programme. Br J Surg. 2010;97:1547–1551. doi: 10.1002/bjs.7184.
    1. Lee JH, Han HS. A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc. 2005;19:168–173. doi: 10.1007/s00464-004-8808-y.
    1. Jiang ZW, Zhang S, Wang G, Zhao K, Liu J, Ning L, et al. Single-incision laparoscopic distal gastrectomy for early gastric cancer through a homemade single port access device. Hepato-Gastroenterology. 2015;62:518–523.
    1. Chen S, Zou Z, Chen F, Huang Z, Li G. A meta-analysis of fast track surgery for patients with gastric cancer undergoing gastrectomy. Ann R Coll Surg Engl. 2015;97:3–10. doi: 10.1308/rcsann.2015.97.1.3.
    1. Aoyama T, Yoshikawa T, Hayashi T, Hasegawa S, Tsuchida K, Yamada T, et al. Randomized comparison of surgical stress and the nutritional status between laparoscopy-assisted and open distal gastrectomy for gastric cancer. Ann Surg Oncol. 2014;21:1983–1990. doi: 10.1245/s10434-014-3509-9.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit