The effects of fast-track surgery on inflammation and immunity in patients undergoing colorectal surgery

Feng, Jinhua; Li, Ka; Li, Li; Wang, Xiaodong; Huang, Ming; Yang, Jie; Hu, Yanjie

doi:10.1007/s00384-016-2630-6

Cited by 12 publications

(9 citation statements)

References 21 publications

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“…Robust evidence suggested that ERAS played an important role in attenuating the surgical stress response and accelerating the return to baseline in colorectal cancer surgery[ 38 , 39 ], which was afforded eloquent proof in GC surgery. The inflammatory factors, such as CRP, IL-6 and tumor necrosis factor α, are related to the extent of tissue injury caused by surgery[ 40 , 41 ]. In the present study, the ERAS approaches significantly reduced the concentration of CRP and IL-6 in comparison with SC on days 1, 4 and 7 after gastrectomy for GC, which was consistent with accelerated recovery.…”

Section: Discussionmentioning

confidence: 99%

Application of enhanced recovery after gastric cancer surgery: An updated meta-analysis

Wang

Zhu

Gao

et al. 2018

WJG

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AIMTo provide an updated assessment of the safety and efficacy of enhanced recovery after surgery (ERAS) protocols in elective gastric cancer (GC) surgery.METHODSPubMed, Medline, EMBASE, World Health Organization International Trial Register, and Cochrane Library were searched up to June 2017 for all available randomized controlled trials (RCTs) comparing ERAS protocols and standard care (SC) in GC surgery. Thirteen RCTs, with a total of 1092 participants, were analyzed in this study, of whom 545 underwent ERAS protocols and 547 received SC treatment.RESULTSNo significant difference was observed between ERAS and control groups regarding total complications (P = 0.88), mortality (P = 0.50) and reoperation (P = 0.49). The incidence of pulmonary infection was significantly reduced (P = 0.03) following gastrectomy. However, the readmission rate after GC surgery nearly tripled under ERAS (P = 0.009). ERAS protocols significantly decreased the length of postoperative hospital stay (P < 0.00001) and medical costs (P < 0.00001), and accelerated bowel function recovery, as measured by earlier time to the first flatus (P = 0.0004) and the first defecation (P < 0.0001). Moreover, ERAS protocols were associated with a lower level of serum inflammatory response, higher serum albumin, and superior short-term quality of life (QOL).CONCLUSIONCollectively, ERAS results in accelerated convalescence, reduction of surgical stress and medical costs, improved nutritional status, and better QOL for GC patients. However, high-quality multicenter RCTs with large samples and long-term follow-up are needed to more precisely evaluate ERAS in radical gastrectomy.

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Section: Discussionmentioning

confidence: 99%

Application of enhanced recovery after gastric cancer surgery: An updated meta-analysis

Wang

Zhu

Gao

et al. 2018

WJG

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“…It have been recognized widely that the advantages of laparoscopic surgery such as alleviating surgical stress and reducing respiratory interference could accelerate postoperative recovery [ 35 – 37 ]. To date, some authors have reported that ERAS protocol could accelerate recovery by mitigating the inflammatory response [ 14 , 15 , 38 , 39 ]. Our results suggest the combination of the two methods can further alleviate the inflammation and immune inhibition based on the efficacy of a single method.…”

Section: Discussionmentioning

confidence: 99%

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

Wang

et al. 2017

World J Surg Onc

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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.

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“…After reading titles and abstracts, 119 articles that did not meet the inclusion criteria were excluded, leaving 115 articles. After reading the full text and screening according to the inclusion and exclusion criteria and data completeness, a total of 22 articles with 3702 patients were included, including 1906 patients in the ERAS group and 1796 patients in the control group 10–12,15–33 . A flowchart of the article selection process is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…After reading the full text and screening according to the inclusion and exclusion criteria and data completeness, a total of 22 articles with 3702 patients were included, including 1906 patients in the ERAS group and 1796 patients in the control group. [10][11][12][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] A flowchart of the article selection process is shown in Figure 1. The basic characteristics of the included studies are shown in Table 1.…”

Section: Study Selection and Quality Assessmentmentioning

confidence: 99%

The effects of enhanced recovery after surgery on wound infection, complications, and postoperative hospital stay in patients undergoing colorectal surgery: A systematic review and meta‐analysis

Li,

Wei,

et al. 2023

International Wound Journal

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This study aimed to systematically evaluate the effects of enhanced recovery after surgery (ERAS) on surgical site infections, postoperative complications, and length of hospital stay in patients undergoing colorectal surgery. A comprehensive search was conducted of PubMed, Web of Science, Ovid, EMBASE, The Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data from database inception to April 2023 to identify relevant studies on the application of ERAS in colorectal surgery. Studies were screened, and data were extracted based on predetermined inclusion and exclusion criteria. Meta‐analysis was performed using RevMan 5.4 software. A total of 22 studies, including 3702 patients (ERAS group: 1906; control group: 1796), were included in the final analysis. ERAS significantly reduced the incidence of surgical site infection (odds ratio [OR]: 0.49, 95% confidence interval [CI]: 0.34–0.69, p < 0.001), postoperative complications (OR: 0.33, 95% CI: 0.27–0.41, p < 0.001), and length of hospital stay (standardised mean difference: −1.22 days, 95% CI: −1.66 to −0.77 days, p < 0.001). These findings suggest that ERAS reduces the incidence of surgical site infections and postoperative complications and shortens the length of hospital stay in patients undergoing colorectal surgery. Therefore, ERAS should be promoted and applied in clinical practice.

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The effects of fast-track surgery on inflammation and immunity in patients undergoing colorectal surgery

Abstract: The FTS program can decrease inflammation, maintain immune homeostasis, and improve rehabilitation effects in colorectal surgery patients.

Cited by 12 publications

References 21 publications

Application of enhanced recovery after gastric cancer surgery: An updated meta-analysis

Application of enhanced recovery after gastric cancer surgery: An updated meta-analysis

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

The effects of enhanced recovery after surgery on wound infection, complications, and postoperative hospital stay in patients undergoing colorectal surgery: A systematic review and meta‐analysis

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