Systematic Review About Application Of Fast-track Surgery In Gynecologic Malignancies

Objective :To systematically evaluate the effectiveness and safety of Fast-Track Surgery(FTS)in patients with gynecologic malignancies.Methods:Through the computer to find relevant literatures which were searched from related domestic and foreign databases,such as China national knowledge infrastructure(CNKI),Wanfang database,VIP database,Pubmed database,EMbase database,Cochrane library database and so on.Those literatures were published during2001.01—2016.12,and the language was in English and Chinese.According to the purpose of this study to make and implement inclusion criteria and exclusion criteria strictly,and randomized and non-randomized controlled trials were screened and selected according to the criteria.We evaluate all the included literatures in strict with principles and methods of systematic evaluation recommended by the Cochrane collaboration.After extracting the relevant research data,the data of each group was analyzed by Revman 5.3 software.Results:There are 12 literatures were included in this study.Among them,there were 8randomized controlled trials and 4 non-randomized controlled trials(2 case-control studies and 2 cohort studies).Through comparing FTS group with control group,meta analysis shows that:(1).There was no significant difference in the hospital readmission rate within 30 postoperative days(OR=1.02,95%CI[0.63,1.66],P=0.93);(2).There was no significant difference in the mortality rate(OR= 0.95,95%CI[0.26,3.41],P=0.93);(3).The difference in the rate of postoperative complications was statistically significant(OR=0.49,95%CI[ 0.32,0.73 ],P=0.0006);(4).There wassignificant difference in the time of enteral nutrition after operation(SMD=﹣5.26,95%CI[﹣7.91,﹣2.61],P<0.0001);(5).There was significant difference in the postoperative anal exhaust time(SMD=﹣1.56,95%CI[﹣2.15,﹣0.96],P<0.00001);(6).The difference of the postoperative ambulation time was statistically significant(SMD=﹣4.23,95%CI[﹣6.09,﹣2.36],P<0.00001);(7).There was significant difference in the defecation time after operation(SMD=﹣1.31,95%CI[﹣1.99,﹣0.64],P=0.0001);(8).The length of hospital stay was shortened,and the difference was statistically significant(SMD= ﹣ 1.21,95%CI[ ﹣ 1.65,﹣ 0.77],P<0.00001);(9).The hospital cost was reduced and the difference was statistically significant(SMD=﹣1.84,95%CI[﹣3.00,﹣0.67],P=0.002).Conclusion:Compared with the traditional perioperative routine treatment,the application of fast-track surgery in perioperative period of patients with gynecologic malignancies can accelerate postoperative anal exhaust and defecation,recovery enteral nutrition early,ambulate early,shorten hospitalization time,reduce hospital cost and lower the incidence of complications,furthermore,hospital readmission rate and mortality rate did not significantly increase.This shows that the application of fast-track surgery in the perioperative period of patients with gynecologic malignancies is safe and effective,and does have its certain advantages.