Safety And Effectiveness Of Enhanced Recovery After Surgery In Gastric Cancer During Perioperative Period:A Meta-analysis

Objective:To evaluate the safety and effectiveness of accelerated recoerry after surgery in the perioperative period of gastric cancer.Methods:Search databases such as CNKI,Wanfang,Weipu,China Biomedical Literature(SinoMed),Pubmed,Cochrane Library,Embase,etc.published from January 1995 to December 31,2019 about accelerated rehabilitation surgery in gastric cancer Randomized controlled trials(RTC)used in the perioperative period of radical surgery.Screen the documents that meet the income requirements and read the full text carefully.Perform a rigorous evaluation of each document and extract relevant data from it.Use RevMan5.3 software for integrated analysis.Through the operation status(operation time,intraoperative blood loss,number of lymph node dissection)and postoperative efficacy(anal first exhaust time,first bowel movement time,hospitalization time,hospitalization cost,postoperative C-reactive protein index,postoperative total complications,Postoperative complications,and readmission)in-depth discussion of the application of accelerated rehabilitation surgery in the perioperative period of gastric cancer.Results:1.Literature inclusion: A total of 14 articles are included,and all documents are studied using randomized control methods.Including 10 Chinese documents and 4 English documents.A total of 1324 patients were collected,including 658 in the ERAS group and 666 in the control group.2.Operation time: There was no significant difference in the operation time between the ERAS group and the conventional group [SMD =-0.00,95% CI(-0.13,0.13),P = 0.95].3.Intraoperative blood loss: There was no statistically significant difference between the ERAS group and the conventional group [SMD =-0.06,95% CI(-0.19,0.07),P = 0.40].4.Number of lymph node dissections: The number of lymph node dissections was not statistically different between the ERAS group and the conventional group [WMD =-0.44,95% CI(-2.39,1.51),P = 0.66].5.The first time of anal exhaustion: The first time of anal exhaustion was significantly ahead of the conventional group in the ERAS group,the difference was statistically significant [SMD =-2.11,95% CI(-3.05,-1.16),P <0.0001].6.Time for first bowel movement: The time for first bowel movement in the ERAS group was significantly reduced compared with the conventional group,and the difference was statistically significant [SMD =-1.67,95% CI(-2.74,-0.60),P = 0.002].7.Hospitalization time: The hospitalization time was significantly shorter in the ERAS group than in the conventional group,and the difference was statistically significant [WMD=-2.19,95% CI(-2.81,-1.57),P<0.00001].8.Hospitalization costs: The hospitalization costs in the ERAS group were significantly less than those in the conventional group,and the difference was statistically significant [(SMD =-1.37,95% CI(-2.04,-0.71),P <0.00001)].9.CRP index on the first postoperative day: The CRP level on the first postoperative day was significantly lower than that in the ERAS group,the difference was statistically significant [SMD =-0.72,95% CI(-1.01,-0.42),P < 0.00001].10.Total postoperative complication rate: The total postoperative complication rate in the ERAS group is significantly less than the conventional group,the difference is statistically significant [OR =-0.40,95% CI(-0.28,-0.57),P <0.00001 ].11.The incidence of major complications: The results showed that the incidence of anastomotic leakage,incision infection or liquefaction,and intestinal obstruction were not statistically different between the two groups(P>0.05).Pulmonary complications(including pneumonia,pleural effusion,respiratory symptoms,etc.)and lower extremity deep vein thrombosis were significantly less in the ERAS group than in the conventional group,and the differences were statistically significant [OR=0.40,95% CI(0.23,0.73),P = 0.002];[OR = 0.20,95% CI(0.07,0.62),P = 0.005].12.Re-admission rate: The re-admission rate was not statistically different between the ERAS group and the conventional group [OR=1.36,95% CI(0.30,6.19),P=0.69].Conclusion:1.The concept of accelerated rehabilitation surgery in the perioperative period of gastric cancer can reduce the patient's stress response,which is conducive to the recovery of the gastrointestinal function of the patient after surgery,promotes the patient's postoperative recovery,shortens hospitalization,and saves hospitalization costs.2.Do not increase the operation time,intraoperative blood loss and readmission rate.3.It can reduce the occurrence of postoperative total complications.Through the analysis of various aspects of this article,it can be shown that the accelerated rehabilitation surgery concept is safe and effective in the perioperative period of gastric cancer.Due to the limitations of this article,many high-quality large sample clinical studies are needed to further demonstrate the results of this article.