TY - JOUR
T1 - Systematic review and meta-analysis of enhanced recovery programmes in gastric cancer surgery
AU - Beamish, Andrew James
AU - Chan, David Sheng Yi
AU - Blake, Paul A.
AU - Karran, Alexandra
AU - Lewis, Wyn Griffith
N1 - Publisher Copyright:
© 2015 IJS Publishing Group Limited.
PY - 2015/7/1
Y1 - 2015/7/1
N2 - This systematic review and meta-analysis was performed to determine the influence of enhanced recovery programmes (ERPs) on outcomes after gastric cancer surgery. Medline, Embase, the Cochrane library and ClinicalTrials.gov were searched for studies on outcomes of gastrectomy in enhanced recovery or fast-track programmes. The primary outcome measure was post-operative duration of hospital stay (LOHS), and secondary outcome measures were selected based inclusion in two or more studies. Statistical analysis was performed using standardized mean difference (SMD) and odds ratio (OR) as the summary statistics.Fourteen studies, totalling 1676 patients with gastric cancer were analysed, including nine randomized trials. LOHS was significantly shorter after ERP when compared with control patients (CON, SMD -1.10, 95% confidence interval-1.56 to-0.65, p<0.001), but with significant heterogeneity between studies (I2=93%, p<0.001). ERP was also associated with reduced serum inflammatory response (CRP: SMD -0.68 (-1.16 to-0.19), p=0.007; IL-6: SMD -0.62 (-0.94 to-0.29), p<0.001), less weight loss (SMD -0.79 (-1.11 to-0.46), p<0.001), and lower cost (SMD -1.02 (-1.59 to-0.45), p<0.001), as well as a trend toward shorter duration of intravenous infusion (SMD -2.70 (-5.35 to-0.05), p=0.05). Inclusion in an ERP was not associated with increased post-operative morbidity (OR 0.83 (0.65 to 1.06), p=0.13) or hospital readmission (OR 1.67 (0.88 to 3.19), p=0.12). From this review the authors concluded that multimodal, standardized perioperative gastrectomy care appears feasible, safe and cost effective.
AB - This systematic review and meta-analysis was performed to determine the influence of enhanced recovery programmes (ERPs) on outcomes after gastric cancer surgery. Medline, Embase, the Cochrane library and ClinicalTrials.gov were searched for studies on outcomes of gastrectomy in enhanced recovery or fast-track programmes. The primary outcome measure was post-operative duration of hospital stay (LOHS), and secondary outcome measures were selected based inclusion in two or more studies. Statistical analysis was performed using standardized mean difference (SMD) and odds ratio (OR) as the summary statistics.Fourteen studies, totalling 1676 patients with gastric cancer were analysed, including nine randomized trials. LOHS was significantly shorter after ERP when compared with control patients (CON, SMD -1.10, 95% confidence interval-1.56 to-0.65, p<0.001), but with significant heterogeneity between studies (I2=93%, p<0.001). ERP was also associated with reduced serum inflammatory response (CRP: SMD -0.68 (-1.16 to-0.19), p=0.007; IL-6: SMD -0.62 (-0.94 to-0.29), p<0.001), less weight loss (SMD -0.79 (-1.11 to-0.46), p<0.001), and lower cost (SMD -1.02 (-1.59 to-0.45), p<0.001), as well as a trend toward shorter duration of intravenous infusion (SMD -2.70 (-5.35 to-0.05), p=0.05). Inclusion in an ERP was not associated with increased post-operative morbidity (OR 0.83 (0.65 to 1.06), p=0.13) or hospital readmission (OR 1.67 (0.88 to 3.19), p=0.12). From this review the authors concluded that multimodal, standardized perioperative gastrectomy care appears feasible, safe and cost effective.
KW - Enhanced recovery
KW - Fast track surgery
KW - Gastric cancer
KW - Meta-analysis
KW - Perioperative care
UR - http://www.scopus.com/inward/record.url?scp=84937552176&partnerID=8YFLogxK
U2 - 10.1016/j.ijsu.2015.05.021
DO - 10.1016/j.ijsu.2015.05.021
M3 - Article
C2 - 26004350
AN - SCOPUS:84937552176
SN - 1743-9191
VL - 19
SP - 46
EP - 54
JO - International Journal of Surgery
JF - International Journal of Surgery
ER -