Optimization Of Perioperative Enhanced Recovery After Surgery (ERAS) Pathways For Patients With Gastric Cancer

Background: Recently with the rapid development of enhanced recovery after surgery(ERAS),the perioperative treatment,nursing model of patients have undergone great changes.More and more evidence have confirmed that ERAS measures could effectively reduce the incidence of postoperative complications,and then enhanced recovery.But for some treatment measures remains much controversial.We would like to assess the feasibility and safety of those measures through a systematic review and meta-analysis,and then we evaluated the level of evidence and recommendations according to the GRADE system.Ultimately,we have formed a evidence-based ERAS clinical pathways for gastric cancer patients.Methods: We selected all the studies which about the ERAS programme in patients undergoing gastrectomy,and in especial to randomized controlled trials(RCTs)and well designed meta-analyses from standard databases.And for the controversial measures,we performed a statistical analysis by using Rev Man5.2 software.And then we used Grading of Recommendations,Assessment,Development and Evaluation(GRADE)system to classify the Evidence level and recommendation.Results: We used the RevMan5.2 software re-evaluated the controversial strategies.Meta-analysis results show that:(1)preoperative oral carbohydrate could reduce level of glucose on the first postoperative day,shorten the length of hospital stay and did not increase the risk postoperative complications.(2)early oral feeding could significantly shorten the length of hospital stay,and not increase the risk of perioperative complications.(3)Goal-directed fluid therapy can reduce the risk of postoperative complications,shorten the length of hospital stay.Finally,we used the GRADE system to classify the e vidence level and recommendation.And the quality of evidence was classified as high,moderate,low and very low.And the recommendations were classified as strong and weak.Conclusions: According to the result of the meta-analysis,we have confirmed the above ERAS treatments were safe and feasible.And due to the evidence level and recommendation,we have formed a ERAS clinical pathway.This would eventually promote the design of well designed,multi-institutional randomized trials.