Efficacy and safety of enhanced recovery after surgery in perioperative management of pancreatoduo-denectomy: a Meta analysis

Abstract

Objective To systematically evaluate the efficacy and safety of recovery after surgery (ERAS) in perioperative management of pancreatoduodenectomy. Methods Literatures were researched using the Cochrane Library, PubMed, Embase, CNKI, VANFUN database, CBM, China Science and Technology Journal Database from June 1979 to June 2019 with the key words including enhanced recovery after surgery, fast-track surgery, fast track multi-disciplinary treatment, pancreatoduodenectomy, laparoscopic pancreatoduodenectomy, whipple surgery, 加速康复外科, 快速康复外科, 加速康复综合治疗模式, 胰十二指肠切除术, 腹腔镜胰十二指肠切除术, whipple手术 . The randomized controlled trial or prospective cohort study about traditional perioperative management versus ERAS in perioperative management of pancreatico-duodenectomy were received and enrolled. The patients receiving ERAS in perioperative management and traditional perioperative management were respectively allocated into ERAS group and control group. Two reviewers independently screened literatures, extracted data and assessed the risk of bias. Count data were described as risk ratio (RR) and 95% confidence interval (CI). Measurement data were represented as mean difference (MD) and 95%CI. The heterogeneity of the studies was analyzed using the I2 test. Funnel plot was used to test potential publication bias if the studies included ≥ 5, and no test was needed if the studies included < 5. Results (1) Document retrieval: a total of 8 randomized controlled trials were included. There were 1 187 patients, including 588 in the ERAS group and 599 in the control group. (2) Results of Meta analysis. ① There was no significant difference in the incidence of postoperative hemorrhage between the two groups (RR=0.79, 95%CI: 0.45-1.37, P>0.05). The bilateral symmetry was presented in the funnel plot based on the 8 studies, suggesting that publication bias had little influence on results of Meta analysis. ② There was no significant difference in the incidence of postoperative pancreatic fistula between the two groups (RR=0.97, 95%CI: 0.67-1.39, P>0.05). ③ There was no significant difference in the incidence of postoperative intra-abdominal infection between the two groups (RR=0.76, 95%CI: 0.51-1.12, P>0.05). The bilateral symmetry was presented in the funnel plot based on the 5 studies, suggesting that publication bias had little influence on results of Meta analysis. ④ There was a significant difference in the incidence of postoperative delayed gastric emptying between the two groups (RR=0.46, 95%CI: 0.31-0.67, P 0.05). The left-right asymmetry was presented in the funnel plot based on the 5 studies, suggesting that publication bias may exist in the included studies. Conclusion ERAS in the perioperative management of pancreatoduodenectomy is safe and effective, which can reduce the incidence of postoperative delayed gastric emptying, shorten the time to postoperative first flatus and duration of hospital stay, and reduce the incidence of postoperative overall complications. Key words: Enhanced recovery after surgery; Pancreatoduodenectomy; Efficacy; Safety; Randomized controlled trials; Meta analysis