Systematic Review About Application Of Enhanced Recovery After Surgery In Radical Resection Of Gastric Cancer

Objective To investigate the safety and feasibility of fast track surgery(ERAS) in radical gastrectomy.Methods:The Cochrane library, PubMed, EMBASE,and Chinese biomedical literature databases were searched to identify randomized controlled trails including patients undergoing radical gastrectomy surgery who were treated by ERAS or traditional methods. The five outcome variables were the time to passage of first flatus and first defecation, The length of postoperative hospital stay, medical cost and postoperative complications.The quality of the included articles was assessed by Cochrane Reviewer’s Handbook 5.1 and the meta analys was conducted by Statal2.0.Results:radical operation for carcinoma of stomach:Sixteen published reports involving 1604 participants met the inclusion criteria. Compared with traditional methods, ERAS had better outcomes with shorter time to the passage of flatus(WMD＝-26.178 hours,95% CI:-31.576～-12.824, P<0.05), shorter time to the passage of defecation (WMD=-34.071hours,95%CI:-53.449～-14.693, P<0.05),shorter postoperative hospital stay (WMD=-2.%95days,95 %CI:-3.638～-2.100, P< 0.05), less medical cost (WMD=-0.347ten thousand yuan,95%CI:-0.493～-0.201,P<0.05),and lower postoperative complication rate(RR= 0.597,95%CI:0.435～0.820, P<0.05). Especially, ERAS had a significant lower rate of postoperative digestive tract complications (RR=0.484,95%CI:0.344～0.680, P<0.05). However,there were no significant differences between two methods in the incidence of complications including postoperative pulmonary infection, infection or liquefaction of incision, fistula of anastomosis and postoperative readmission rate (P>0.05).Laparoscopy-assisted radical distal gastrectomy for gastric carcinoma:6 RCTs were included, with a total amount of 411 cases. Meta analysis demonstrated that:ERAS showed the potency of shorter time to the passage of flatus, yet with no statistical significance (WMD=-25.450 h,95%CI:-51.633～ 0.733, P>0.05). ERAS had shorter postoperative hospital stay (WMD=-1.899 d,95%CI:-3.035～-0.763, P<0.05), less medical cost (WMD=-0.214 ten thousand yuan,95%CI:-0.306～-0.122, P<0.05), and lower postoperative complication rate (RR= 0.600,95%CI:0.380～0.948, P<0.05).than conventional group. However,there was no significant difference between the two methods in the incidence of complications including postoperative digestive tract complications, pulmonary infection, infection or liquefaction of incision, and postoperative readmission rate (P>0.05).Conclusion:The application of ERAS in the peri-operated period of radical gastrectomy surgery shortens the time to passage of first flatus and first defecation, the postoperative hospital stay, as well as lowers the medical cost and the postoperative complication rate. In conclusion, our results suggest suggest that ERAS is safe and effective during the perioperative period of radical gastrectomy and it seens to be promising in the clinical application.