Systematic review and meta-analysis of enhanced recovery programmes in gastric cancer surgery
- 1 July 2015
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in International Journal of Surgery
- Vol. 19, 46-54
- https://doi.org/10.1016/j.ijsu.2015.05.021
Abstract
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 (I-2 = 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. (C) 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.Keywords
This publication has 34 references indexed in Scilit:
- Is the critical pathway effective for the treatment of gastric cancer?Journal of the Korean Surgical Society, 2011
- Neoadjuvant Chemotherapy Compared With Surgery Alone for Locally Advanced Cancer of the Stomach and Cardia: European Organisation for Research and Treatment of Cancer Randomized Trial 40954Journal of Clinical Oncology, 2010
- Multimodal Optimization of Surgical Care Shows Beneficial Outcome in Gastrectomy SurgeryJournal of Parenteral and Enteral Nutrition, 2010
- Reduction of hospital stay and cost after the implementation of a clinical pathway for radical gastrectomy for gastric cancerGastric Cancer, 2008
- Gastrectomy with extended lymphadenectomy for primary treatment of gastric cancerBritish Journal of Surgery, 2005
- Incidence of anemia in patients receiving neoadjuvant chemotherapy for locally advanced esophagogastric cancerThe Annals of Thoracic Surgery, 2004
- Survival of patients with oesophageal and gastric cancers in EuropeEuropean Journal of Cancer, 1998
- A Prospective Randomized Trial Comparing R1 Subtotal Gastrectomy with R3 Total Gastrectomy for Antral CancerAnnals of Surgery, 1994
- Randomized comparison of R1 and R2 gastrectomy for gastric carcinomaBritish Journal of Surgery, 1988