Abstract
BackgroundBoth laparoscopic and fast-track surgery (FTS) have shown some advantages in colorectal surgery. However, the effectiveness of using both methods together is unclear. We performed this meta-analysis to compare the effects of FTS with those of traditional perioperative care in laparoscopic colorectal cancer surgery.MethodsWe searched the PubMed, EMBASE, Cochrane Library, and Ovid databases for eligible studies until April 2014. The main end points were the duration of the postoperative hospital stay, time to first flatus after surgery, time of first bowel movement, total postoperative complication rate, readmission rate, and mortality.ResultsFive randomized controlled trials and 5 clinical controlled trials with 1,317 patients were eligible for analysis. The duration of the postoperative hospital stay (weighted mean difference [WMD], –1.64 days; 95% confidence interval [CI], –2.25 to –1.03; p < 0.001), time to first flatus (WMD, –0.40 day; 95% CI, –0.77 to –0.04; p = 0.03), time of first bowel movement (WMD, –0.98 day; 95% CI, –1.45 to –0.52; p < 0.001), and total postoperative complication rate (risk ratio [RR], 0.67; 95% CI, 0.56–0.80; p < 0.001) were significantly reduced in the FTS group. No significant differences were noted in the readmission rate (RR, 0.64; 95% CI, 0.41–1.01; p = 0.06) or mortality (RR, 1.55; 95% CI, 0.42–5.71; p = 0.51).ConclusionAmong patients undergoing laparoscopic colorectal cancer surgery, FTS is associated with a significantly shorter postoperative hospital stay, more rapid postoperative recovery, and, notably, greater safety than is expected from traditional care.
Highlights
Both laparoscopic and fast-track surgery (FTS) have shown some advantages in colorectal surgery
Studies were excluded for the following reasons: FTS and traditional perioperative care were not compared or patients with benign colorectal disease were included, or the study did not provide an FTS protocol or the protocol applied fewer than six fast-track elements
Analysis was performed on 1,317 patients in the FTS group (n = 696) or traditional care group (n = 621)
Summary
Both laparoscopic and fast-track surgery (FTS) have shown some advantages in colorectal surgery. The effectiveness of using both methods together is unclear We performed this meta-analysis to compare the effects of FTS with those of traditional perioperative care in laparoscopic colorectal cancer surgery. Surgery, which is still the most common treatment for colorectal cancer, remains a high-risk procedure with clinically significant postoperative stress, complications, and a lengthy postoperative hospital stay. Fasttrack surgery (FTS), termed an enhanced recovery program, was initiated by the Kehlet group in 2001 [6,7]. This program combines several methods, such as patient education, epidural or regional anesthesia, minimally invasive techniques, no routine use of drains or nasogastric tubes, optimal pain control, and early enteral nutrition and ambulation [6]. Many randomized controlled trials (RCTs) and meta-analyses have demonstrated that FTS is applicable and effective in colorectal surgery [8,9,10,11]
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