Abstract
BackgroundClinical evidence has proved that enhanced recovery after surgery (ERAS) can improve short-term clinical outcomes after various types of surgeries, but the long-term benefits have not yet been examined, especially with respect to cancer surgeries. Therefore, a systematic review of the current evidence was conducted.MethodsThe Pubmed, Cochrane Library, Embase, and Web of Science databases were searched using the following key words as search terms: “ERAS” or “enhanced recovery” or “fast track”, “oncologic outcome”, “recurrence”, “metastasis”, “long-term outcomes”, “survival”, and “cancer surgery”. The articles were screened using the inclusion and exclusion criteria, and the data from the included studies were extracted and analyzed.ResultsA total of twenty-six articles were included in this review. Eighteen articles compared ERAS and conventional care, of which, 12 studies reported long-term overall survival (OS), and only 4 found the improvement by ERAS. Four studies reported disease-free survival (DFS), and only 1 found the improvement by ERAS. Five studies reported the outcomes of return to intended oncologic treatment after surgery (RIOT), and 4 found improvements in the ERAS group. Seven studies compared high adherence to ERAS with low adherence, of which, 6 reported the long-term OS, and 3 showed improvements by high adherence. One study reported high adherence could reduce the interval from surgery to RIOT. Four studies reported the effect of altering one single item within the ERAS protocol, but the results of 2 studies were controversial regarding the long-term OS between laparoscopic and open surgery, and 1 study showed improvements in OS with restrictive fluid therapy.ConclusionsThe use of ERAS in cancer surgeries can improve the on-time initiation and completion of adjuvant chemotherapy after surgery, and the high adherence to ERAS can lead to better outcomes than low adherence. Based on the current evidence, it is difficult to determine whether the ERAS protocol is associated with long-term overall survival or cancer-specific survival.
Highlights
Clinical evidence has proved that enhanced recovery after surgery (ERAS) can improve short-term clinical outcomes after various types of surgeries, but the long-term benefits have not yet been examined, especially with respect to cancer surgeries
Of these 26 articles, 3 were randomized trials [12, 13, 15], which were evaluated by Jadad score, and the other 23 were prospective or retrospective cohort studies, which were evaluated by the Newcastle-Ottawa Scale (NOS)
Eighteen articles compared conventional care with ERAS [10– 21, 29–34], 7 studies compared high adherence to ERAS with low adherence [16, 22–26, 34], and 4 studies [27–29, 35] investigated the outcome of one single item altered within ERAS protocol
Summary
Clinical evidence has proved that enhanced recovery after surgery (ERAS) can improve short-term clinical outcomes after various types of surgeries, but the long-term benefits have not yet been examined, especially with respect to cancer surgeries. ERAS improves clinical outcomes and quality of care, and significantly reduces the cost of hospitalization [2–6]. The majority of the clinical evidence regarding the benefits of ERAS describes short-term outcomes; the long-term benefits of ERAS are not fully elucidated, especially with respect to cancer surgeries. We conducted a literature search to identify studies on oncologic and long-term outcomes that examined: (1) ERAS versus conventional care, (2) high adherence to ERAS versus low adherence, and (3) the effects of altering one single item within the ERAS protocol
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