Fast-track surgery versus traditional perioperative care in laparoscopic colorectal cancer surgery: a meta-analysis

Jun-Hua Zhao, Jing-Xu Sun, Peng Gao, Xiao-Wan Chen, Yong-Xi Song, Xuan-Zhang Huang, Hui-Mian Xu, Zhen-Ning Wang, Jun-Hua Zhao, Jing-Xu Sun, Peng Gao, Xiao-Wan Chen, Yong-Xi Song, Xuan-Zhang Huang, Hui-Mian Xu, Zhen-Ning Wang

Abstract

Background: Both laparoscopic and fast-track surgery (FTS) have shown some advantages in colorectal surgery. However, the effectiveness of using both methods together is unclear. We performed this meta-analysis to compare the effects of FTS with those of traditional perioperative care in laparoscopic colorectal cancer surgery.

Methods: We searched the PubMed, EMBASE, Cochrane Library, and Ovid databases for eligible studies until April 2014. The main end points were the duration of the postoperative hospital stay, time to first flatus after surgery, time of first bowel movement, total postoperative complication rate, readmission rate, and mortality.

Results: Five randomized controlled trials and 5 clinical controlled trials with 1,317 patients were eligible for analysis. The duration of the postoperative hospital stay (weighted mean difference [WMD], -1.64 days; 95% confidence interval [CI], -2.25 to -1.03; p < 0.001), time to first flatus (WMD, -0.40 day; 95% CI, -0.77 to -0.04; p = 0.03), time of first bowel movement (WMD, -0.98 day; 95% CI, -1.45 to -0.52; p < 0.001), and total postoperative complication rate (risk ratio [RR], 0.67; 95% CI, 0.56-0.80; p < 0.001) were significantly reduced in the FTS group. No significant differences were noted in the readmission rate (RR, 0.64; 95% CI, 0.41-1.01; p = 0.06) or mortality (RR, 1.55; 95% CI, 0.42-5.71; p = 0.51).

Conclusion: Among patients undergoing laparoscopic colorectal cancer surgery, FTS is associated with a significantly shorter postoperative hospital stay, more rapid postoperative recovery, and, notably, greater safety than is expected from traditional care.

Figures

Figure 1
Figure 1
Flow chart of articles selection.
Figure 2
Figure 2
Meta-analysis of postoperative hospital stay.
Figure 3
Figure 3
Meta-analysis of time to first flatus.
Figure 4
Figure 4
Meta-analysis of first bowel movement time.
Figure 5
Figure 5
Meta-analysis of total postoperative complication rate.
Figure 6
Figure 6
Meta-analysis of the readmission rate.
Figure 7
Figure 7
Meta-analysis of thirty-day postoperative mortality.
Figure 8
Figure 8
Funnel plot of the studies on the rate of postoperative complications.

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Pre-publication history
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