Lindemann Kristina, Kok Peey-Sei, Stockler Martin, Jaaback Ken, Brand Alison
*NHMRC Clinical Trials Centre, University of Sydney; and †Australian New Zealand Gynecological Oncology Goup (ANZGOG), Camperdown; ‡Crown Princess Mary Cancer Centre, Westmead Hospital, Wentworthville; §Department of Gynecologic Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway; ∥Department of Gynaecological Oncology, John Hunter Hospital, Newcastle; and ¶Department of Gynaecological Oncology, Westmead Hospital, Wentworthville, New South Wales, Australia.
Int J Gynecol Cancer. 2017 Jul;27(6):1274-1282. doi: 10.1097/IGC.0000000000000981.
We sought to summarize the evidence for interventions aiming at enhanced recovery after surgery (ERAS) in ovarian cancer through a systematic review.
We searched MEDLINE, EMBASE, and The Cochrane Library for studies testing ERAS interventions in patients undergoing surgery for ovarian cancer. Study selection and data extraction were done independently by 2 reviewers with disagreements resolved by discussion with a senior, third reviewer.
We identified 25 studies including 1648 participants with ovarian cancer. Nine observational studies addressed ERAS protocols. Four of them were prospective, and 3 included historical controls. The other 16 studies reported single interventions, for example, early feeding, omission of pelvic drains, early orogastric tube removal, Doppler-guided fluid management, and patient-controlled epidural analgesia. Early feeding protocols were tested in 7 of the 12 randomized trials. Early feeding appeared to be safe and was associated with significantly faster recovery of bowel function.
Few studies have specifically studied ERAS interventions in ovarian cancer. All studies on protocols including multiple interventions were susceptible to bias. Early feeding is the intervention that is best supported by randomized trials. Application of evidence for ERAS derived from nonovarian cancer is challenged by the differences not only in the scope of surgery but also in ovarian cancer patients' comorbidities. Postoperative morbidity is particularly high in these patients because of their poor nutritional status, perioperative fluids shifts, and long operating times. These patients may also show excessive response to surgical stress. Innovative, randomized trials are needed to reliably determine the feasibility, safety, and effectiveness of specific ERAS interventions in ovarian cancer.
我们试图通过系统评价总结针对卵巢癌手术加速康复（ERAS）干预措施的证据。
我们检索了MEDLINE、EMBASE和Cochrane图书馆，以查找在接受卵巢癌手术的患者中测试ERAS干预措施的研究。研究选择和数据提取由2名评审员独立完成，如有分歧则与资深的第三名评审员讨论解决。
我们确定了25项研究，包括1648名卵巢癌患者。9项观察性研究涉及ERAS方案。其中4项为前瞻性研究，3项包括历史对照。其他16项研究报告了单一干预措施，例如早期进食、不放置盆腔引流管、早期拔除口胃管、多普勒引导下的液体管理以及患者自控硬膜外镇痛。12项随机试验中有7项测试了早期进食方案。早期进食似乎是安全的，并且与肠道功能恢复明显加快有关。
很少有研究专门针对卵巢癌的ERAS干预措施进行研究。所有关于包括多种干预措施的方案的研究都容易产生偏差。早期进食是随机试验支持力度最大的干预措施。不仅手术范围不同，而且卵巢癌患者的合并症也存在差异，这给将非卵巢癌来源的ERAS证据应用带来了挑战。由于营养状况差（营养状况差）、围手术期液体转移和手术时间长，这些患者术后发病率特别高。这些患者对手术应激也可能表现出过度反应。需要进行创新性的随机试验，以可靠地确定特定ERAS干预措施在卵巢癌中的可行性、安全性和有效性。
