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

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Abstrakt

Tytuł:: Enhanced recovery versus conventional care in gastric cancer surgery: a meta-analysis of randomized and non-randomized controlled trials.
Autorzy:: Wee IJY; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.; Division of General Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore.
Syn NL; Division of General Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore.; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, NUHS Tower Block, Level 8, 1E Kent Ridge Road, Singapore, 119228, Singapore.
Shabbir A; Division of General Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore.; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, NUHS Tower Block, Level 8, 1E Kent Ridge Road, Singapore, 119228, Singapore.
Kim G; Division of General Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore.
So JBY; Division of General Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore. jimmy_.; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, NUHS Tower Block, Level 8, 1E Kent Ridge Road, Singapore, 119228, Singapore. jimmy_.
Źródło:: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association [Gastric Cancer] 2019 May; Vol. 22 (3), pp. 423-434. Date of Electronic Publication: 2019 Feb 25.
Typ publikacji:: Comparative Study; Journal Article; Meta-Analysis; Review
Język:: English
Imprint Name(s):: Original Publication: Tokyo : Springer-Verlag Tokyo, c1998-
MeSH Terms:: Postoperative Complications*
Standard of Care*
Gastrectomy/*mortality
Laparoscopy/*mortality
Length of Stay/*statistics & numerical data
Patient Readmission/*statistics & numerical data
Stomach Neoplasms/*surgery
Humans ; Non-Randomized Controlled Trials as Topic ; Prognosis ; Randomized Controlled Trials as Topic ; Recovery of Function ; Survival Rate
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Contributed Indexing:: Keywords: ERAS; Enhanced recovery after surgery; Gastric cancer; Gastric surgery
Entry Date(s):: Date Created: 20190227 Date Completed: 20190903 Latest Revision: 20200225
Update Code:: 20240105
DOI:: 10.1007/s10120-019-00937-9
PMID:: 30805742
: Czasopismo naukowe

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Introduction: Enhanced recovery after surgery (ERAS) protocols have been successfully integrated into peri-operative management of different cancer surgeries such as colorectal cancer. Their value for gastric cancer surgery, however, remains uncertain.
Methods: A search for randomized and observational studies comparing ERAS versus conventional care in gastric cancer surgery was performed according to PRISMA guidelines. Random-effects meta-analyses with inverse variance weighting were conducted, and quality of included studies was assessed using the Cochrane risk-of-bias tool and Newcastle-Ottawa scale (PROSPERO: CRD42017080888).
Results: Twenty-three studies involving 2686 patients were included. ERAS was associated with reduced length of hospital stay (WMD-2.47 days, 95% CI - 3.06 to - 1.89, P < 0.00001), time to flatus (WMD-0.70 days, 95% CI - 1.02 to - 0.37, P < 0.0001), and hospitalization costs (WMD-USD$ 4400, 95% CI - USD$ 5580 to - USD$ 3210, P < 0.00001), with consistent results across open and laparoscopic surgery. Postoperative morbidity and 30-day mortality were similar, although a higher rate of readmission was observed in the ERAS group (RR = 1.95, 95% CI 1.03-3.67, P = 0.04). Patients in the ERAS arm had significantly attenuated C-reactive protein levels on days 3/4 and 7, interleukin-6 levels on days 1, and 3/4, and tumor necrosis factor-α levels on days 3/4 postoperatively.
Conclusion: Compared to conventional care, ERAS reduces hospital stay, costs, surgical stress response and time to return of gut function, without increasing post-operative morbidity in gastric cancer surgery. However, precaution is necessary to reduce the increased risk of hospital readmission when adopting ERAS.

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