Kennelly Patrick, Davey Matthew G, Griniouk Diana, Calpin Gavin, Donlon Noel E
Department of Surgery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
Dis Esophagus. 2025 Jan 7;38(1). doi: 10.1093/dote/doae118.
Enhanced Recovery After Surgery (ERAS) protocols are evidence-based care improvement pathways which are perceived to expedite patient recovery following surgery. Their utility in the setting of oesophagectomy remains unclear. The aim of this study was to perform a systematic review and meta-analysis of randomised clinical trials (RCTs) to evaluate the impact of ERAS protocols on recovery following oesophagectomy compared to standard care. A systematic review was performed in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. Meta-analysis was performed using Review Manager (Version 5.4). Six RCTs including 850 patients were included in this meta-analysis. Overall complication rate (Odds Ratio (OR): 0.35, Confidence Interval (CI): 0.21, 0.59, P < 0.0001), pulmonary complications (OR: 0.40, CI: 0.24, 0.67, P = 0.0005), post-operative length of stay (LOS) (OR -1.88, CI -2.05, -1.70, P < 0.00001) and time to post-operative flatus (OR: -5.20, CI: -9.46, -0.95, P = 0.02) favoured the ERAS group. There was no difference noted for anastomotic leak (OR: 0.55, CI: 0.24, 1.28, P = 0.17), cardiac complications (OR: 0.86, CI: 0.30, 2.46, P = 0.78), gastrointestinal complications (OR: 0.51, CI: 0.23, 1.17, P = 0.11), wound complications (OR: 0.85, CI: 0.28, 2.58, P = 0.78), mortality (OR: 1.37, CI: 0.26, 7.4, P = 0.71), and 30-day re-admission rate (OR: 1.29, CI: 0.30, 5.47, P = 0.73) between ERAS and standard care groups. ERAS implementation improved post-operative complications, LOS, and time to flatus following oesphagectomy. These results support the robust adoption of ERAS in patients indicated to undergo oesphagectomy.
术后加速康复（ERAS）方案是基于证据的护理改进路径，被认为可加速患者术后康复。其在食管切除术中的效用仍不明确。本研究的目的是对随机临床试验（RCT）进行系统评价和荟萃分析，以评估与标准护理相比，ERAS方案对食管切除术后康复的影响。根据系统评价和荟萃分析的首选报告项目指南进行了系统评价。使用Review Manager（5.4版）进行荟萃分析。本荟萃分析纳入了6项RCT，共850例患者。总体并发症发生率（优势比（OR）：0.35，置信区间（CI）：0.21，0.59，P < 0.0001）、肺部并发症（OR：0.40，CI：0.24，0.67，P = 0.0005）、术后住院时间（LOS）（OR -1.88，CI -2.05，-1.70，P < 0.00001）和术后胃肠排气时间（OR：-5.20，CI：-9.46，-0.95，P = 0.02）有利于ERAS组。ERAS组与标准护理组在吻合口漏（OR：0.55，CI：0.24，1.28，P = 0.17）、心脏并发症（OR：0.86，CI：(0.30)，2.46，P = 0.78）、胃肠道并发症（OR：0.51，CI：0.23，1.17，P = 0.11）、伤口并发症（OR：0.85，CI：0.28，2.58，P = 0.78）、死亡率（OR：1.37，CI：0.26，7.4，P = 0.71）和30天再入院率（OR：1.29，CI：0.30，5.47，P = 0.73）方面未发现差异。实施ERAS可改善食管切除术后的并发症、住院时间和胃肠排气时间。这些结果支持在拟行食管切除术的患者中大力采用ERAS。
