Influence of enhanced recovery after surgery programs on laparoscopy-assisted gastrectomy for gastric cancer: a systematic review and meta-analysis of randomized control trials

Abstract

BackgroundThis meta-analysis is aimed to evaluate the feasibility and safety of enhanced recovery after surgery (ERAS) programs in gastric cancer patients undergoing laparoscopy-assisted gastrectomy (LAG).MethodsWe performed a meta-analysis of randomized control trials involving either enhanced recovery after surgery (ERAS)/fast track surgery (FTS) for patients underwent LAG. EMBASE, Pubmed, Web of science, and Cochrane Library were searched. Primary outcomes included the length of postoperative hospital stay, cost of hospitalization, postoperative complications, and readmission rate.ResultsFive randomized control trials were eligible for analysis. There were 159 cases in FTS group and 156 cases in conventional care group. Compared with conventional care group, FTS group relates to shorter postoperative hospital stay (WMD − 2.16; 95% CI − 3.05 to − 1.26, P < 0.00001), less cost of hospitalization (WMD − 4.72; 95% CI − 6.88 to − 2.55, P < 0.00001), shorter time to first flatus (WMD − 9.72; 95% CI − 13.75 to − 5.81, P < 0.00001), lower level of C-reaction protein on postoperative days 3 or 4 (WMD − 19.66; 95% CI − 28.98 to − 10.34, P < 0.00001), higher level of albumin on postoperative day 4 (WMD 3.45; 95% CI 2.01 to 4.89, P < 0.00001), and postoperative day 7 (WMD 5.63; 95% CI 1.01 to 10.24, P = 0.02). Regarding postoperative complications, no significant differences were observed between FTS group and conventional care group (OR 0.63, 95% CI 0.37 to 1.09, P = 0.10). The readmission rate of FTS group was comparable to conventional care group (WMD 3.14; 95% CI 0.12 to 81.35, P = 0.49).ConclusionsAmong patients undergoing LAG, FTS is associated with shorter postoperative hospital stay, rapid postoperative recovery, and decreased cost without increasing complications or readmission rate. The combined effects of the two methods could further accelerate clinical recovery of gastric cancer patients.

Enhanced recovery versus conventional care in gastric cancer surgery: a meta-analysis of randomized and non-randomized controlled trials

“…Our analysis demonstrated an increased rate of readmission in the ERAS arm, a contentious finding that was also shown by Ding et al [36]. This trend, albeit non-significant, was also seen in other meta-analyses [37,38,41]. As this is contrariwise to the goals of ERAS to attenuate surgical stress and promote recovery, further research is warranted to investigate this antithetical phenomenon.…”

“…Our findings demonstrate that the ERAS program resulted in shorter length of hospital stay (LOS), reduced hospital costs, reduced time to return of gut function, without compromising on risks of morbidity and mortality; however, an increased rate of readmission was observed in the ERAS arm, a finding not demonstrated in previous meta-analyses. Furthermore, there were weaknesses in these studies [35][36][37][38][39][40][41][42][43]. All except one meta-analysis [38] included only randomized controlled trials (RCTs); Li et al [37] only examined laparoscopic gastrectomy; Ding et al [36] limited their analysis to English language articles.…”

NFIB promotes cell growth, aggressiveness, metastasis and EMT of gastric cancer through the Akt/Stat3 signaling pathway

“…To date, gastric cancer (GC) is still one of the most lethal and common cancers worldwide, which is often associated with a high mortality and morbidity (17)(18)(19). The majority of GC patients are diagnosed at an advanced stage and receive a poor prognosis (20).…”

Current status of the “enhanced recovery after surgery” program in gastric cancer surgery

“…Regarding the current state of the ERAS protocol in the field of gastric cancer surgery, four meta‐analyses have been published in or since 2017 (Table ) . Li et al and Li et al focused on the outcomes of ERAS in patients undergoing laparoscopic gastrectomy.…”

“…Li et al and Li et al focused on the outcomes of ERAS in patients undergoing laparoscopic gastrectomy. They also showed that ERAS contributed to shorter postoperative hospital stay, rapid postoperative recovery, and decreased cost without increasing complications or readmission rate among patients undergoing laparoscopic gastrectomy . Ding et al and Wang et al focused on the outcomes of ERAS in patients undergoing gastrectomy .…”