Systematic review and meta-analysis of enhanced recovery programmes in gastric cancer surgery

Abstract

This systematic review and meta-analysis was performed to determine the influence of enhanced recovery programmes (ERPs) on outcomes after gastric cancer surgery. Medline, Embase, the Cochrane library and ClinicalTrials.gov were searched for studies on outcomes of gastrectomy in enhanced recovery or fast-track programmes. The primary outcome measure was post-operative duration of hospital stay (LOHS), and secondary outcome measures were selected based inclusion in two or more studies. Statistical analysis was performed using standardized mean difference (SMD) and odds ratio (OR) as the summary statistics. Fourteen studies, totalling 1676 patients with gastric cancer were analysed, including nine randomized trials. LOHS was significantly shorter after ERP when compared with control patients (CON, SMD -1.10, 95% confidence interval -1.56 to -0.65, p < 0.001), but with significant heterogeneity between studies (I(2) = 93%, p < 0.001). ERP was also associated with reduced serum inflammatory response (CRP: SMD -0.68 (-1.16 to -0.19), p = 0.007; IL-6: SMD -0.62 (-0.94 to -0.29), p < 0.001), less weight loss (SMD -0.79 (-1.11 to -0.46), p < 0.001), and lower cost (SMD -1.02 (-1.59 to -0.45), p < 0.001), as well as a trend toward shorter duration of intravenous infusion (SMD -2.70 (-5.35 to -0.05), p = 0.05). Inclusion in an ERP was not associated with increased post-operative morbidity (OR 0.83 (0.65 to 1.06), p = 0.13) or hospital readmission (OR 1.67 (0.88 to 3.19), p = 0.12). From this review the authors concluded that multimodal, standardized perioperative gastrectomy care appears feasible, safe and cost effective.

Keywords: Enhanced recovery; Fast track surgery; Gastric cancer; Meta-analysis; Perioperative care.