Fast-track surgery in gastrectomy for gastric cancer: a systematic review and meta-analysis

Abstract

Fast-track surgery aims to attenuate the surgical stress response, reduce complications, and shorten hospital stay. The goal of the present meta-analysis is to assess the safety and effectiveness of fast-track surgery in patients undergoing gastrectomy for gastric cancer compared with conventional perioperative care. PubMed, Embase, the Cochrane Central Register of Controlled Trials, and reference lists of the identified studies were searched to identify randomized clinical trials that compared fast-track surgery with conventional perioperative care in patients undergoing gastrectomy for gastric cancer. Five studies with a total of 400 patients were included in the meta-analysis. Meta-analysis shows that postoperative hospital stay (weighted mean difference (WMD) -1.87days, 95% confidence interval (CI), -2.46 to -1.28days, P < 0.00001), time to first passage of flatus (WMD -0.71days, 95% CI, -1.03 to -0.39days, P < 0.0001), and hospital costs (WMD -505.87 dollars, 95% CI, -649.91 to -361.84 dollars, P < 0.00001) were significantly reduced for fast-track surgery. No significant differences were found for readmission rates (relative risk (RR), 1.97 95% CI, 0.37 to 10.64, P = 0.43) and total postoperative complications (RR, 0.99 95% CI, 0.56 to 1.76, P = 0.97). Fast-track surgery is safe and effective in gastrectomy for gastric cancer. Further randomized trials are needed to strengthen the conclusions.