| Background Gastric cancer(GC)is a malignant disease with high incidence and mortality rates worldwide.The latest global cancer statistical data shows GC rank the fifth common cancer and the second main cause of cancer-related death.Surgery is the main measures to cure this disease.Postoperative recovery of patients with gastric cancer is affected by a variety of factors,including physical fitness,nutritional status,surgical trauma and stress response.Enhanced recovery after surgery(ERAS)was a multidisciplinary approach aiming to accelerate postoperative recovery,shorten hospital stay,reduce surgical stress response and minimize hospitalization expenditure.Its core idea is to reduce the surgical trauma and stress response through perioperative optimization measures,maintain the stability of the internal environment,make the body organs function recover quickly,and reach the discharge standard.It included preoperative nutritional support,reduce preoperative eating time,intraoperative minimally invasive surgery and heat preservation measures,the management of perioperative fluid balance,a variety of joint measures to relieve pain,not regular preoperative conventional enema and gastrointestinal decompression,postoperative drainage tube,early postoperative eating and ambulation and a series of effective care measures.To date,ERAS has been successfully applied to perioperative management of cancer patients.However,its clinical value for gastric cancer patients who underwent laparoscopic gastrectomy remains unclear.Objective In this study,a comprehensive and systematic search was made of the domestic and foreign literatures on the randomized controlled trial(RCTS)and clinical controlled trials(CCTS)of ERAS used in laparoscopic radical gastrectomy and traditional perioperative nursing for laparoscopic radical gastrectomy.To valuate the feasibility and safety of ERAS programs for gastric cancer patients who underwent laparoscopic gastrectomy.Methods PubMed,EMBASE,Cochrane Library,CBM,CNKI,Weipu and Wanfang database were searched up to January 2020 for all relevant randomized controlled trials(RCTs)comparing ERAS programs(experimental group)with traditional perioperative care(control group)in laparoscopic gastrectomy for GC.After screening for relevant literature based on the inclusion and exclusion criteria,data extraction,quality assessment,and meta-analysis was performed using the Review Manager 5.3 software.Results A total of 18 articles involving 1890 patients(922 in the experimental group and 968 in the control group)were included in this meta-analysis,which included 14 RCTs and 4 CCTs.The results of this meta-analysis showed that the patients in the ERAS group had a earlier oral feeding [SMD=-6.75,95%CI(-8.76,-4.74),P<0.01],The first time out of bed after surgery was shorter[SMD=-3.98,95%CI(-5.83,-2.14),P<0.01],Serum CRP was lower on the first day after surgery[WMD=-16.04,95 %CI(-20.21,-11.86,P<0.01)],shorter postoperative hospital stay[WMD=-2.82,95%CI(-4.80,-0.84),P=0.005],shorter The total hospital stay[WMD=-2.55,95%CI(-2.76,-2.34),P<0.01]and less hospitalization fees [WMD=-0.69,95%CI(-1.00,-0.37),P<0.01]than those in traditional perioperative care group.In addition,ERAS was significantly associated with earlier first flatus [SMD=-1.56,95%CI(-1.58,-1.53),P<0.001],earlier gastric tube removal [WMD =-1.62,95% CI(-2.60,-0.64),P <0.01] and reduced postoperative pain[WMD=-1.44,95 % CI(-2.08,-0.81),P<0.01].The incidence of postoperative complications in the ERAS group was significantly lower than that in traditional perioperative care group [OR=0.53,95%CI(0.38,0.74),P <0.01].Conclusion 1.ERAS used in laparoscopic radical gastrectomy could accelerate postoperative recovery of patients with gastric cancer.2.ERAS used in laparoscopic radical gastrectomy could reduce the postoperative complications and surgical stress response of gastric cancer patients and improve the perioperative safety. |
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