Zhao Jun-Hua, Sun Jing-Xu, Gao Peng, Chen Xiao-Wan, Song Yong-Xi, Huang Xuan-Zhang, Xu Hui-Mian, Wang Zhen-Ning
Department of Surgical Oncology and General Surgery, the First Hospital of China Medical University, Shenyang 110001, People's Republic of China.
BMC Cancer. 2014 Aug 23;14:607. doi: 10.1186/1471-2407-14-607.
Both laparoscopic and fast-track surgery (FTS) have shown some advantages in colorectal surgery. However, the effectiveness of using both methods together is unclear. We performed this meta-analysis to compare the effects of FTS with those of traditional perioperative care in laparoscopic colorectal cancer surgery.
We searched the PubMed, EMBASE, Cochrane Library, and Ovid databases for eligible studies until April 2014. The main end points were the duration of the postoperative hospital stay, time to first flatus after surgery, time of first bowel movement, total postoperative complication rate, readmission rate, and mortality.
Five randomized controlled trials and 5 clinical controlled trials with 1,317 patients were eligible for analysis. The duration of the postoperative hospital stay (weighted mean difference [WMD], -1.64 days; 95% confidence interval [CI], -2.25 to -1.03; p < 0.001), time to first flatus (WMD, -0.40 day; 95% CI, -0.77 to -0.04; p = 0.03), time of first bowel movement (WMD, -0.98 day; 95% CI, -1.45 to -0.52; p < 0.001), and total postoperative complication rate (risk ratio [RR], 0.67; 95% CI, 0.56-0.80; p < 0.001) were significantly reduced in the FTS group. No significant differences were noted in the readmission rate (RR, 0.64; 95% CI, 0.41-1.01; p = 0.06) or mortality (RR, 1.55; 95% CI, 0.42-5.71; p = 0.51).
Among patients undergoing laparoscopic colorectal cancer surgery, FTS is associated with a significantly shorter postoperative hospital stay, more rapid postoperative recovery, and, notably, greater safety than is expected from traditional care.
腹腔镜手术和快速康复外科（FTS）在结直肠癌手术中均显示出一定优势。然而，两种方法联合使用的效果尚不清楚。我们进行了这项荟萃分析，以比较FTS与传统围手术期护理在腹腔镜结直肠癌手术中的效果。
我们检索了PubMed、EMBASE、Cochrane图书馆和Ovid数据库，以查找截至2014年4月的符合条件的研究。主要终点包括术后住院时间、术后首次排气时间、首次排便时间、术后总并发症发生率、再入院率和死亡率。
五项随机对照试验和五项临床对照试验共1317例患者符合分析条件。FTS组的术后住院时间（加权平均差[WMD]，-1.64天；95%置信区间[CI]，-2.25至-1.03；p < 0.001）、首次排气时间（WMD，-0.40天；95%CI，-0.77至-0.04；p = 0.03）、首次排便时间（WMD，-0.98天；95%CI，-1.45至-0.52；p < 0.001）和术后总并发症发生率（风险比[RR]，0.67；95%CI，0.56 - 0.80；p < 0.001）均显著降低。再入院率（RR，0.64；95%CI，0.41 - 1.01；p = 0.06）或死亡率（RR，1.55；95%CI，0.42 - 5.71；p = 0.51）无显著差异。
在接受腹腔镜结直肠癌手术的患者中，FTS与术后住院时间显著缩短、术后恢复更快相关，值得注意的是，其安全性高于传统护理预期。
