Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
World Journal of Surgical Oncology
Published in: World Journal of Surgical Oncology 1/2017

Open Access 01-12-2017 | Review

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

Authors: Zhengyan Li, Qian Wang, Bofei Li, Bin Bai, Qingchuan Zhao

Published in: World Journal of Surgical Oncology | Issue 1/2017

Login to get access

Abstract

Background

This 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).

Methods

We 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.

Results

Five 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).

Conclusions

Among 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.
Literature
1.
Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, Jemal A, XQ Y, He J. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66:115–32.CrossRefPubMed
2.
Vinuela EF, Gonen M, Brennan MF, Coit DG, Strong VE. Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg. 2012;255:446–56.CrossRefPubMed
3.
Jiang L, Yang KH, Guan QL, Cao N, Chen Y, Zhao P, Chen YL, Yao L. Laparoscopy-assisted gastrectomy versus open gastrectomy for resectable gastric cancer: an update meta-analysis based on randomized controlled trials. Surg Endosc. 2013;27:2466–80.CrossRefPubMed
4.
Lin JXHC, Zheng CH, Li P, Xie JW, Wang JB, Lu J. Laparoscopy-assisted gastrectomy with D2 lymph node dissection for advanced gastric cancer without serosa invasion: a matched cohort study from South China. World J Surg Oncol. 2013;11:4.CrossRefPubMedPubMedCentral
5.
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;345:763–4.CrossRefPubMed
6.
Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;83:630–41.CrossRef
7.
Grant MC, Yang D, CL W, Makary MA, Wick EC. Impact of enhanced recovery after surgery and fast track surgery pathways on healthcare-associated infections: results from a systematic review and meta-analysis. Ann Surg. 2017;265:68–79.CrossRefPubMed
8.
Zhao Y, Qin H, Wu Y, Xiang B. Enhanced recovery after surgery program reduces length of hospital stay and complications in liver resection: a PRISMA-compliant systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017;96:e7628.CrossRef
9.
Deng X, Chen X, Huo Z, Shi Y, Jin Z, Feng H, Wang Y, Wen C, Qian H, Zhao R, Qiu W, Shen B, Peng C. Modified protocol for enhanced recovery after surgery is beneficial for Chinese cancer patients undergoing pancreaticoduodenectomy. Oncotarget. 2017;8:47841–8.PubMedPubMedCentral
10.
Cerantola Y, Valerio M, Persson B, Jichlinski P, Ljungqvist O, Hubner M, Kassouf W, Muller S, Baldini G, Carli F, et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS®) society recommendations. Clin Nutr. 2013;32:879–87.CrossRefPubMed
11.
Yang R, Tao W, Chen Y-y, Zhang B-h, Tang J-m, Zhong S, Chen X-x. Enhanced recovery after surgery programs versus traditional perioperative care in laparoscopic hepatectomy: a meta-analysis. Int J Surg. 2016;36:274–82.CrossRefPubMed
12.
Zhao JH SJ, Gao P, Chen XW, Song YX, Huang XZ, Xu HM, Wang ZN. Fast-track surgery versus traditional perioperative care in laparoscopic colorectal cancer surgery: a meta-analysis. BMC Cancer. 2014;14:607. doi:10.​1186/​1471-2407-14-607.
13.
Li P, Fang F, Cai JX, Tang D, Li QG, Wang DR. Fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for colorectal malignancy: a meta-analysis. World J Gastroenterol. 2013;19:9119–26.CrossRefPubMedPubMedCentral
14.
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;14:620–7.CrossRefPubMed
15.
Li YJ, Huo TT, Xing J, An JZ, Han ZY, Liu XN, Zhao QC. Meta-analysis of efficacy and safety of fast-track surgery in gastrectomy for gastric cancer. World J Surg. 2014;38:3142–51.CrossRefPubMed
16.
Ding JSB, Song P, Liu S, Chen H, Feng M, Guan W. The application of Enhanced Recovery After Surgery/fast track surgery in gastrectomy for gastric cancer: a systematic review and meta-analysis. Oncotarget. 2017;8:75699–711.PubMedPubMedCentral
17.
Kim JW, Kim WS, Cheong J-H, Hyung WJ, Choi S-H, Noh SH. Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer: a randomized clinical trial. World J Surg. 2012;36:2879–87.CrossRefPubMed
18.
Chen Hu J, Xin Jiang L, Cai L, Tao Zheng H, Yuan Hu S, Bing Chen H, Chang Wu G, Fei Zhang Y, Chuan Lv Z. Preliminary experience of fast-track surgery combined with laparoscopy-assisted radical distal gastrectomy for gastric cancer. J Gastrointest Surg. 2012;16:1830–9.CrossRefPubMed
19.
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;21:13339–44.CrossRefPubMedPubMedCentral
20.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.CrossRefPubMedPubMedCentral
21.
Mortensen K, Nilsson M, Slim K, Schafer M, Mariette C, Braga M, Carli F, Demartines N, Griffin SM, Lassen K. Enhanced recovery after surgery G: consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS®) society recommendations. Br J Surg. 2014;101:1209–29.CrossRefPubMed
22.
Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.CrossRefPubMedPubMedCentral
23.
Lu J, Huang C-m, Zheng C-h, Li P, Xie J-w, Wang J-bb, Lin J-x, Chen Q-y, Cao L-l, Lin M: Short- and long-term outcomes after laparoscopic versus open total gastrectomy for elderly gastric cancer patients: a propensity score-matched analysis. J Gastrointest Surg 2015, 19:1949-1957.
24.
Li YQJ, Cao H. Application of enhanced recovery after surgery for patients with laparoscopic radical gastrectomy. Zhonghua Wei Chang Wai Ke Za Zhi. 2016;19:269–73.PubMed
25.
Zou ZH, Zhao LY, Mou TY, YF H, Yu J, Liu H, Chen H, JM W, An SL, Li GX. Laparoscopic vs open D2 gastrectomy for locally advanced gastric cancer: a meta-analysis. World J Gastroenterol. 2014;20:16750–64.CrossRefPubMedPubMedCentral
26.
Chen K, Xu XW, Mou YP, Pan Y, Zhou YC, Zhang RC, Wu D. Systematic review and meta-analysis of laparoscopic and open gastrectomy for advanced gastric cancer. World J Surg Oncol. 2013;11:182.CrossRefPubMedPubMedCentral
27.
Wang JF, Zhang SZ, Zhang NY, ZY W, Feng JY, Ying LP, Zhang JJ. Laparoscopic gastrectomy versus open gastrectomy for elderly patients with gastric cancer: a systematic review and meta-analysis. World J Surg Oncol. 2016;14:90.CrossRefPubMedPubMedCentral
28.
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.CrossRefPubMedPubMedCentral
29.
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;19:1391–8.CrossRefPubMed
30.
Feng FJG, Li JP, Li XH, Shi H, Zhao ZW, GS W, Liu XN, Zhao QC. Fast-track surgery could improve postoperative recovery in radical total gastrectomy patients. World J Gastroenterol. 2013;19:3642–8.CrossRefPubMedPubMedCentral
31.
Petrowsky H, Demartines N, Rousson V, Clavien P-A. Evidence-based value of prophylactic drainage in gastrointestinal surgery. Ann Surg. 2004;240:1074–85.CrossRefPubMedPubMedCentral
32.
JO R. Surgical drainage: an historical perspective. Br J Surg. 1986;73:422-6.
33.
Lee J, Choi YY, An JY, Seo SH, Kim DW, Seo YB, Nakagawa M, Li S, Cheong JH, Hyung WJ, Noh SH. Do all patients require prophylactic drainage after gastrectomy for gastric cancer? The experience of a high-volume center. Ann Surg Oncol. 2015;22:3929–37.CrossRefPubMed
34.
Conlon KC, Labow D, Leung D, Smith A, Jarnagin W, Coit DG, Merchant N, Brennan MF. Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg. 2011;234:487–93.CrossRef
35.
36.
Veenhof AA, Vlug MS, van der Pas MH, Sietses C, van der Peet DL, de Lange-de Klerk ES, Bonjer HJ, Bemelman WA, Cuesta MA. Surgical stress response and postoperative immune function after laparoscopy or open surgery with fast track or standard perioperative care: a randomized trial. Ann Surg. 2012;255:216–21.CrossRefPubMed
37.
Kawamura H, Yokota R, Homma S, Kondo Y. Comparison of respiratory function recovery in the early phase after laparoscopy-assisted gastrectomy and open gastrectomy. Surg Endosc. 2010;24:2739–42.CrossRefPubMed
38.
Feng J, Li K, Li L, Wang X, Huang M, Yang J, Hu Y. The effects of fast-track surgery on inflammation and immunity in patients undergoing colorectal surgery. Int J Color Dis. 2016;31:1675–82.CrossRef
39.
Chen L, Sun L, Lang Y, Wu J, Yao L, Ning J, Zhang J, Xu S.Fast-track surgery improves postoperative clinical recovery and cellular and humoral immunity after esophagectomy for esophageal cancer. BMC Cancer. 2016;16:449. doi:10.​1186/​s12885-016-2506-8.
40.
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;9:3345–51.PubMedPubMedCentral
41.
Senkal M, Zumtobel V, Bauer KH, Marpe B, Wolfram G, Frei A, Eickhoff U, Kemen M. Outcome and cost-effectiveness of perioperative enteral immunonutrition in patients undergoing elective upper gastrointestinal tract surgery: a prospective randomized study. Arch Surg. 1999;134:1309–16.CrossRefPubMed
42.
Yan X, Zhou FX, Lan T, Xu H, Yang XX, Xie CH, Dai J, ZM F, Gao Y, Chen LL. Optimal postoperative nutrition support for patients with gastrointestinal malignancy: a systematic review and meta-analysis. Clin Nutr. 2017;36:710–21.CrossRefPubMed
43.
Shu XL, Kang K, LJ G, Zhang YS. Effect of early enteral nutrition on patients with digestive tract surgery: a meta-analysis of randomized controlled trials. Exp Ther Med. 2016;12:2136–44.PubMedPubMedCentral
44.
Lewis SJ, Andersen HK, Thomas S. Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: a systematic review and meta-analysis. J Gastrointest Surg. 2009;13:569–75.CrossRefPubMed
45.
Nikniaz Z, Somi MH, Nagashi S, Nikniaz L. Impact of early enteral nutrition on nutritional and immunological outcomes of gastric cancer patients undergoing gastrostomy: a systematic review and meta-analysis. Nutr Cancer. 2017;69:693–701.CrossRefPubMed
Metadata
Title
Influence of enhanced recovery after surgery programs on laparoscopy-assisted gastrectomy for gastric cancer: a systematic review and meta-analysis of randomized control trials
Authors
Zhengyan Li
Qian Wang
Bofei Li
Bin Bai
Qingchuan Zhao
Publication date
01-12-2017
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2017
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/s12957-017-1271-8

Other articles of this Issue 1/2017

World Journal of Surgical Oncology 1/2017 Go to the issue

Research

Surgical treatment in non-small cell lung cancer with pulmonary oligometastasis

Case report

Liver necrosis shortly after pancreaticoduodenectomy with resection of the replaced left hepatic artery

Review

Evolution in the surgical management of gastric cancer: is extended lymph node dissection back in vogue in the USA?

Research

Prognostic significance of microvascular invasion in tumor stage for hepatocellular carcinoma

Research

Oncofertility in patients with stage I epithelial ovarian cancer: fertility-sparing surgery in young women of reproductive age

Case Report

Malignant acanthosis nigricans: an early diagnostic clue for gastric adenocarcinoma