Systematic Evaluation And Meta Analysis Of ERAS Concept In Perioperative Period Of Laparoscopic Radical Total Gastrectomy

Objective: to systematically evaluate and demonstrate the perioperative safety and efficacy of the concept of ERAS in laparoscopic total gastrectomy.Method: The research on ERAS in laparoscopic total gastric application published in domestic and foreign journals was retrieved from China cnki database,wanfang database,Pubmed database,Web of Science database,Medline database,etc.,until December 2019.Data in relevant literatures were carefully screened and extracted,and two researchers with certain statistical knowledge were used to evaluate the quality of included literatures.Review Manager 5.3 was used for analysis and meta-analysis was used to obtain the value of odds ratio OR,95% confidence interval(CI)and weighted mean difference(WMD).RESULTS:after careful screening and collation,a total of 12 related literatures were included in this study,and the final sample size of the experimental group(ERAS group)was 251 cases,while that of the control group(no ERAS concept was applied)was 840 cases.Compared with the control group,the intraoperative blood loss in the ERAS group was less [WMD(95%CI):-11.94(-22.58,-1.30),P=0.03],and the postoperative first ventilation time and postoperative first feeding time were both earlier.The WMD value was [WMD(95%CI):-11.40(-15.86,-6.93),P<0.00001],[WMD(95%CI):-1.35(-2.32,-0.38),P=0.006],postoperative hospital stay was shortened [WMD(95%CI):-1.39(-2.01,-0.78),P<0.00001],and the total postoperative complications were less.[OR(95%ci): 2.02(1.27,3.23),P=0.003];the first postoperative discharge time was advanced [OR(95%ci):-0.35(-0.59,-0.10),P=0.005];the operation time [WMD(95%ci):-3.06(-16.70,10.58),P=0.66];the number of lymph nodes dissected [WMD(95%ci):-0.52(-1.13,0.10),P=0.10];hospital expenses [OR(95%ci):0.16(-0.60,0.93),P=0.67] was not statistically significant.The total postoperative complications were fixed effect models,while the others were random effect models.Conclusion: the concept of ERAS is safe and effective in laparoscopic total gastrectomy during perioperative period,which has certain advantages compared with the traditional perioperative management,and can be popularized in reducing intraoperative blood loss and accelerating postoperative recovery.