| Objective Fast-track surgery(FTS)pathway is a promising programme for surgical patients and has been applied to several surgical diseases.FTS is much superior to conventional perioperative care.The study on therapeutic efficiency and costs between fast track surgery(FTS)programme and regular programme in laparoscopic gastrectomy for gastric cancer using a systematic review.Methods We searched the literature in PubMed(1966-2016.7),EMBASE.com(1974-2016.7),Cochrane Libraiy(-2016.7),Web of Science(1980-2016.7),VIP,Wan-Fang Database(1997-2016.7)and China National Knowledge Infrastructure(CNKI)(1994-2016.7),Chinese Scientific Journals Fulltext Database(CSJD)(1989-2016.7),CBM(1978-2016.7),and Chinese Science Citation Database(1989-2016.7),and the related references and websites were also traced.No language restriction was applied.were searched to collect randomized controlled trials(RCTs)or clinical controlled trials(CCTs)on the therapeutic efficiency and costs between fast track surgery(FTS)programme and regular programme in laparoscopic gastrectomy for gastric cancer.Two reviewers independently screened literature,extracted data,and assessed the risk of bias of included studies.Statistical were analysed systematically using RevMan 5.3 software.Results We included 9 randomized controlled trials and 3 controlled clinical trial involving940 patients were included.There were 469 patients in the study group and 471 patients in the control group.analysis the selected articles,Although 77%(10/13)of studies were identified as RCT by "random",only 77%(10/13)reported the detailed information based on the methods of randomization.8%(1/13)mentioned the blinding.15%(2/13)provided at length the information about the rateand reason of the drop-out.100%(13/13)described the inclusion and exclusion criteria and provided the information about adverse events.100%(13/13)reported the methods of statistical analysis.100%(13/13)provided the information about data integrity.The result of meta analysis showed that compared with the conventional care,the earlier first flatus 、 duration ofhospital stay、ambulation time、time to oral intaking liquid diet、decrease hospital charge、the incidence of postoperative complications were[MD= –4.28,95%CI(–5.74,–2.83),P<0.00001]、[MD= –1.85,95%CI(–2.56,–1.15),P<0.000 01]、[MD= –2.00,95%CI(–2.77,–1.22),P<0.000 01]、[MD= –3.02,95%CI(–5.47,–0.57),P<0.000 01],[MD= –0.86,95%CI(–1.44,–0.28),P<0.000 01]、[OR=0.57,95%CI(–0.39,0.85),P=0.006],there was difference between two groups in earlier first flatus 、 duration of hospital stay 、ambulation time、time to oral intaking liquid diet、decrease hospital charge、the incidence of postoperative complications.But the harvested lymph node numbe、operative time、volume of intraoperative blood loss were[OR=1.14,95%CI(0.68,1.92),P=0.62]、[MD= –6.39,95%CI(–21.17,8.39),P=0.40]、[MD= 0.24,95%CI(–0.05,0.54),P=0.011],So there was no significant difference between two groups in harvested lymph node number、operative time、volume of intraoperative blood loss。Conclusions Based on current evidence,the FTS protocol compared with gastric cancer patients who underwent laparoscopic gastrectomy or FTS,the FTS combine with laparoscopic gastrectomy for gastric cancer has shorter the earlier first flatus,reduce duration of hospital stay,ambulation time,time to oral intaking liquid diet,decrease hospital charge,as well as less the incidence of postoperative complications.But there was no significant difference between two groups in harvested lymph node number、operative time、volume of intraoperative blood loss. |
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