The efficacy and safety of enhanced recovery after surgery (ERAS) Program in laparoscopic distal gastrectomy: a systematic review and meta-analysis of randomized controlled trials
Qihui Tian, Hongying Wang, Tianyu Guo, Bing Yao, Yefu Liu, Bo Zhu
Abstract
Background: although eRas Program had some advantages in laparoscopic distal gastrectomy (lDG), its efficacy and safety remained unclear.We conducted a systematic review and meta-analysis to assess the efficacy and safety of the eRas group and the traditional care (tc) group in lDG.Methods: Multiple databases were retrieved from 1 January 2000 to 30 april 2023.the risk ratio (RR), standardized mean difference (sMD) and their 95% confidence interval (ci) were used to estimate the results.Results: Our meta-analysis contained 17 randomized controlled trials (Rcts) studies, which comprised 1468 patients.Regarding efficacy, the eRas group had significantly shorter postoperative time to first flatus (sMD = -1.29 [95% ci: -1.68, -0.90]), shorter time to first defecation (sMD = -1.26[95% ci: -1.90, -0.61]), shorter hospital stays (sMD = -0.99[95% ci: -1.34, -0.63]), and lower hospitalization costs (sMD = -1.17[95% ci: -1.86, -0.48]) compared to the tc group.Furthermore, in the eRas group, c-reactive protein levels were lower on postoperative days 1, 3 or 4, and 7; albumin levels were higher on postoperative days 3 or 4 and 7; and interleukin-6 levels were lower on postoperative days 1 and 3. Regarding safety, the overall postoperative complication rate was lower in the eRas group (RR: 0.76 [95% ci: 0.60, 0.97]), but there was no significant difference in the individual postoperative complication rate.Other indicators were also not statistically significant.Conclusion: the combination of eRas Program with laparoscopy surgery was safe and effective for the perioperative management of patients with distal gastric cancer. KEY MESSAGES1. there was no systematic review and meta-analysis on the efficacy and safety of eRas Program in lDG, so we included 17 studies comprising 1468 patients.2. the results indicated that the application of eRas Program in lDG can significantly improve treatment effect, accelerate patient recovery, shorten hospital stays, and reduce medical costs.it was worth noting that eRas was effective in reducing the risk of complications, such as postoperative lung infections.3. these findings bring new ideas and enlightenment to clinicians under the traditional nursing mode, and provide evidence-based medicine evidence for clinical practice.