Published online Apr 14, 2018. doi: 10.3748/wjg.v24.i14.1562
Peer-review started: February 6, 2018
First decision: February 26, 2018
Revised: March 3, 2018
Accepted: March 7, 2018
Article in press: March 6, 2018
Published online: April 14, 2018
To provide an updated assessment of the safety and efficacy of enhanced recovery after surgery (ERAS) protocols in elective gastric cancer (GC) surgery.
PubMed, Medline, EMBASE, World Health Organization International Trial Register, and Cochrane Library were searched up to June 2017 for all available randomized controlled trials (RCTs) comparing ERAS protocols and standard care (SC) in GC surgery. Thirteen RCTs, with a total of 1092 participants, were analyzed in this study, of whom 545 underwent ERAS protocols and 547 received SC treatment.
No significant difference was observed between ERAS and control groups regarding total complications (P = 0.88), mortality (P = 0.50) and reoperation (P = 0.49). The incidence of pulmonary infection was significantly reduced (P = 0.03) following gastrectomy. However, the readmission rate after GC surgery nearly tripled under ERAS (P = 0.009). ERAS protocols significantly decreased the length of postoperative hospital stay (P < 0.00001) and medical costs (P < 0.00001), and accelerated bowel function recovery, as measured by earlier time to the first flatus (P = 0.0004) and the first defecation (P < 0.0001). Moreover, ERAS protocols were associated with a lower level of serum inflammatory response, higher serum albumin, and superior short-term quality of life (QOL).
Collectively, ERAS results in accelerated convalescence, reduction of surgical stress and medical costs, improved nutritional status, and better QOL for GC patients. However, high-quality multicenter RCTs with large samples and long-term follow-up are needed to more precisely evaluate ERAS in radical gastrectomy.
Core tip: Enhanced recovery after surgery (ERAS) has emerged as an optimal perioperative strategy for improving clinical outcomes in gastric cancer surgery. However, numerous controversies exist with regard to ERAS practice after gastrectomy. To our knowledge, this study is the largest meta-analysis of randomized controlled trials to date, incorporating 1092 participants, of whom 545 received ERAS protocols and 547 received standard care, to assess the role of ERAS for radical gastrectomy. Our review clarified that ERAS results in accelerated convalescence, reduction of surgical stress and medical costs, improved nutritional status, and better quality of life for gastric cancer patients.