Li Shuangjiang, Zhou Kun, Che Guowei, Yang Mei, Su Jianhua, Shen Cheng, Yu Pengming
Department of Thoracic Surgery.
Department of Rehabilitation, Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
Cancer Manag Res. 2017 Nov 16;9:657-670. doi: 10.2147/CMAR.S150500. eCollection 2017.
Enhanced recovery after surgery (ERAS) program is an effective evidence-based multidisciplinary protocol of perioperative care, but its roles in thoracic surgery remain unclear. This systematic review of randomized controlled trials (RCTs) aims to investigate the efficacy and safety of the ERAS programs for lung cancer surgery.
We searched the PubMed and EMBASE databases to identify the RCTs that implemented an ERAS program encompassing more than four care elements within at least two phases of perioperative care in lung cancer surgery. The heterogeneity levels between studies were estimated by the Cochrane Collaborations. A qualitative review was performed if considerable heterogeneity was revealed. Relative risk (RR) and weighted mean difference served as the summarized statistics for the meta-analyses. Additional analyses were also performed to perceive potential bias risks.
A total of seven RCTs enrolling 486 patients were included. The meta-analysis indicated that the ERAS group patients had significantly lower morbidity rates (RR=0.64; <0.001), especially the rates of pulmonary (RR=0.43; <0.001) and surgical complications (RR=0.46; =0.010), than those of control group patients. No significant reduction was found in the in-hospital mortality (RR=0.70; =0.58) or cardiovascular complications (RR=1.46; =0.25). In the qualitative review, most of the evidence reported significantly shortened length of hospital and intensive care unit stay and decreased hospitalization costs in the ERAS-treated patients. No significant publication bias was detected in the meta-analyses.
Our review demonstrates that the implementation of an ERAS program for lung cancer surgery can effectively accelerate postoperative recovery and save hospitalization costs without compromising patients' safety. A worldwide consensus guideline is urgently required to standardize the ERAS protocols for elective lung resections in the future.
术后加速康复（ERAS）计划是一种基于证据的有效的多学科围手术期护理方案，但其在胸外科手术中的作用仍不明确。本系统评价随机对照试验（RCT）旨在研究ERAS计划用于肺癌手术的有效性和安全性。
我们检索了PubMed和EMBASE数据库，以识别在肺癌手术围手术期至少两个阶段实施包含四个以上护理要素的ERAS计划的RCT。通过Cochrane协作组织估计研究之间的异质性水平。如果发现显著异质性，则进行定性综述。相对风险（RR）和加权平均差用作荟萃分析的汇总统计量。还进行了额外的分析以识别潜在偏倚风险。
共纳入7项RCT，涉及486例患者。荟萃分析表明，与对照组患者相比，ERAS组患者的发病率显著更低（RR=0.64；<0.001），尤其是肺部（RR=0.43；<0.001）和手术并发症（RR=0.46；=0.010）的发生率。住院死亡率（RR=0.70；=0.58）或心血管并发症（RR=1.46；=0.25）没有显著降低。在定性综述中，大多数证据报告称，接受ERAS治疗的患者住院时间和重症监护病房住院时间显著缩短，住院费用降低。荟萃分析中未检测到显著的发表偏倚。
我们的综述表明，肺癌手术实施ERAS计划可有效加速术后康复并节省住院费用，且不影响患者安全。迫切需要制定全球共识指南，以规范未来择期肺切除术的ERAS方案。
