Key result
Enhanced recovery programmes for gastric cancer surgery significantly reduced post-operative duration of hospital stay compared to control (SMD -1.10; 95% CI -1.56 to -0.65; p<0.001).
Why the study?
Do enhanced recovery programmes reduce post-operative duration of hospital stay in patients with gastric cancer undergoing gastrectomy?
Meta-Analysis (n=1,676)
Do enhanced recovery programmes reduce post-operative duration of hospital stay in patients with gastric cancer undergoing gastrectomy?
Standardized Mean Difference: -1.1 (95% CI -1.56–-0.65)
p-value: p=< 0.001
Enhanced recovery programmes for gastric cancer surgery significantly reduce hospital stay, inflammatory response, and costs without increasing morbidity or readmissions.
Supports routine implementation of enhanced recovery programmes after gastric cancer surgery; strengthens Level 1 evidence for perioperative optimization.
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.
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Beamish et al. (2015) conducted a meta-analysis in Gastric cancer (n=1,676). Enhanced recovery programmes (ERPs) vs. Control was evaluated on Post-operative duration of hospital stay (LOHS) (SMD -1.10, 95% CI -1.56 to -0.65, p=< 0.001). Enhanced recovery programmes for gastric cancer surgery significantly reduced post-operative duration of hospital stay compared to control (SMD -1.10; 95% CI -1.56 to -0.65; p<0.001).
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