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Application of enhanced recovery after gastric cancer surgery: An updated meta-analysis
AIM: To provide an updated assessment of the safety and efficacy of enhanced recovery after surgery (ERAS) protocols in elective gastric cancer (GC) surgery. METHODS: PubMed, Medline, EMBASE, World Health Organization International Trial Register, and Cochrane Library were searched up to June 2017 f...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5897860/ https://www.ncbi.nlm.nih.gov/pubmed/29662294 http://dx.doi.org/10.3748/wjg.v24.i14.1562 |
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author | Wang, Liu-Hua Zhu, Ren-Fei Gao, Cheng Wang, Shou-Lin Shen, Li-Zong |
author_facet | Wang, Liu-Hua Zhu, Ren-Fei Gao, Cheng Wang, Shou-Lin Shen, Li-Zong |
author_sort | Wang, Liu-Hua |
collection | PubMed |
description | AIM: To provide an updated assessment of the safety and efficacy of enhanced recovery after surgery (ERAS) protocols in elective gastric cancer (GC) surgery. METHODS: PubMed, 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. RESULTS: No 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). CONCLUSION: Collectively, 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. |
format | Online Article Text |
id | pubmed-5897860 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-58978602018-04-17 Application of enhanced recovery after gastric cancer surgery: An updated meta-analysis Wang, Liu-Hua Zhu, Ren-Fei Gao, Cheng Wang, Shou-Lin Shen, Li-Zong World J Gastroenterol Meta-Analysis AIM: To provide an updated assessment of the safety and efficacy of enhanced recovery after surgery (ERAS) protocols in elective gastric cancer (GC) surgery. METHODS: PubMed, 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. RESULTS: No 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). CONCLUSION: Collectively, 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. Baishideng Publishing Group Inc 2018-04-14 2018-04-14 /pmc/articles/PMC5897860/ /pubmed/29662294 http://dx.doi.org/10.3748/wjg.v24.i14.1562 Text en ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. |
spellingShingle | Meta-Analysis Wang, Liu-Hua Zhu, Ren-Fei Gao, Cheng Wang, Shou-Lin Shen, Li-Zong Application of enhanced recovery after gastric cancer surgery: An updated meta-analysis |
title | Application of enhanced recovery after gastric cancer surgery: An updated meta-analysis |
title_full | Application of enhanced recovery after gastric cancer surgery: An updated meta-analysis |
title_fullStr | Application of enhanced recovery after gastric cancer surgery: An updated meta-analysis |
title_full_unstemmed | Application of enhanced recovery after gastric cancer surgery: An updated meta-analysis |
title_short | Application of enhanced recovery after gastric cancer surgery: An updated meta-analysis |
title_sort | application of enhanced recovery after gastric cancer surgery: an updated meta-analysis |
topic | Meta-Analysis |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5897860/ https://www.ncbi.nlm.nih.gov/pubmed/29662294 http://dx.doi.org/10.3748/wjg.v24.i14.1562 |
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