Meta-analysis Of Clinical Effects Of Enhanced Recovery After Surgery In Laparoscopic Radical Nephrectomy

Objective: Enhanced recovery after surgery(ERAS)has been shown to be an effective,reliable and practical clinical approach,but its impact on laparoscopic radical nephrectomy(LRN)is unclear.This study systematically evaluates the value of applying the ERAS concept in the perioperative period of LRN.Subjects and Methods: Pub Med,Cochrane library,Embase,CBM,CNKI,Wanfang database and VIP database were searched to compare the clinical research on the application of enhanced recovery after surgery(ERAS)and traditional rehabilitation surgery management mode in laparoscopic radical nephrectomy by May 26 2022.Two independent reviewers conducted literature screening,data collection and quality evaluation,and used Rev Man 5.4 version for data analysis.Result: A total of 14 articles were included,including 9 randomized controlled trials and 5 retrospective cohort studies,with a total of 1339 patients.636 cases in ERAS group and 703 cases in traditional rehabilitation surgery group.The results of metaanalysis showed that the first exhaust time [SMD=-2.54,95% CI(-3.34,-1.75),P<0.00001],the first eating time [SMD =-2.97,95% CI(-3.42,-1.91),P <0.00001],the first out of bed [SMD=-3.00,95% CI(-3.62,-2.38),P < 0.00001],the catheter removal time [SMD=-3.17,95% CI(-4.62,-1.71),P <0.00001] and the drainage tube removal time [SMD=-2.36,95% CI(-3.15,-1.56),P <0.00001] were earlier,the postoperative hospital stay [MD=-2.84,95% CI(-3.72,-1.95),P<0.00001] was Shorter,the total incidence of postoperative complications[MD=0.51,95% CI(0.38,0.68),P<0.00001] and the hospitalization costs [MD=-0.53,95% CI(-0.64,-0.43),P<0.00001] were lower in the perioperative patients treated with enhanced recovery after surgery.But there was no significant difference in operation time [MD=-1.16,95% CI(-2.77,0.45),P=0.16] and intraoperative bleeding [MD=-0.99,95% CI(-2.51,0.54),P=0.21] between the two groups.Conclusions:The application of ERAS in laparoscopic radical nephrectomy can significantly accelerate the postoperative recovery of patients,reduce the postoperative hospital stay,hospitalization costs,and reduce the incidence of postoperative complications.Due to the small number of available studies and potential heterogeneity,the above conclusions still need more and better high-quality studies to verify.