Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Surg Oncol. 2020 Mar;32:75-87. doi: 10.1016/j.suronc.2019.11.004. Epub 2019 Nov 25.
Enhanced recovery after surgery (ERAS) protocols have been effective in improving postoperative recovery after major abdominal surgeries including colorectal cancer surgery, however its impact after gastric cancer surgery is unclear. A systematic review and meta-analysis was conducted to evaluate the effect of ERAS after gastric cancer surgery. Medline, EMBASE, CENTRAL, and PubMed was searched from database inception to December 2018. Randomized controlled trials (RCTs) comparing ERAS versus standard care in gastric cancer surgery were included. Outcomes included the postoperative length of stay (LOS), hospital costs, time to first flatus, defecation, oral intake, and ambulation after surgery, and complications. Pooled estimates were calculated using random-effects meta-analysis. The GRADE approach assessed overall quality of evidence. 18 RCTs involving 1782 patients were included. ERAS significantly reduced the LOS (Mean Difference (MD) -1.78 days, 95%CI -2.17 to -1.40, P < 0.0001), reduced hospital costs (MD -650 U S. dollars, 95%CI -840 to -460, P < 0.0001), and reduced time to first flatus, defecation, ambulation, and oral intake. ERAS had significantly lower rates of pulmonary infections (Risk Ratio (RR) 0.48, 95%CI 0.28 to 0.82, P = 0.007), but not surgical site infections, anastomotic leaks, and postoperative complications. However, ERAS significantly increased readmissions (RR 2.43, 95%CI 1.09 to 5.43, P = 0.03). The quality of evidence was low to moderate for all outcomes. Implementation of an ERAS protocol may reduce LOS, costs, and time to return of function after gastric cancer surgery compared to conventional recovery. However, ERAS may increase the number of postoperative readmissions, albeit with no impact on the rate of postoperative complications.
术后加速康复（ERAS）方案已被证实可有效改善包括结直肠癌手术在内的大型腹部手术后的术后恢复，但它对胃癌手术后的影响尚不清楚。我们进行了一项系统评价和荟萃分析，以评估胃癌手术后 ERAS 的效果。我们从数据库建立之初到 2018 年 12 月检索了 Medline、EMBASE、CENTRAL 和 PubMed。纳入了比较胃癌手术中 ERAS 与标准护理的随机对照试验（RCT）。结局包括术后住院时间（LOS）、住院费用、首次排气、排便、经口进食和术后活动时间，以及并发症。使用随机效应荟萃分析计算汇总估计值。采用 GRADE 方法评估总体证据质量。纳入了 18 项 RCT，共 1782 例患者。ERAS 显著降低了 LOS（平均差值（MD）-1.78 天，95%CI-2.17 至-1.40，P<0.0001），降低了住院费用（MD-650 美元，95%CI-840 至-460，P<0.0001），并缩短了首次排气、排便、活动和经口进食的时间。ERAS 肺部感染的发生率显著降低（风险比（RR）0.48，95%CI 0.28 至 0.82，P=0.007），但手术部位感染、吻合口漏和术后并发症发生率无差异。然而，ERAS 显著增加了再入院率（RR 2.43，95%CI 1.09 至 5.43，P=0.03）。所有结局的证据质量均为低到中等。与传统恢复相比，胃癌手术后实施 ERAS 方案可能会减少 LOS、费用和恢复功能的时间。然而，ERAS 可能会增加术后再入院的数量，但对术后并发症的发生率没有影响。
