Purpose: To assess the impact of enhanced recovery after surgery (ERAS) protocols in pancreaticoduodenectomy. Methods: Four databases were searched for studies describing ERAS program in patients undergoing pancreatic surgery published up to May 01, 2018. Primary outcomes were mortality, readmission, reoperation and postoperative complications. Secondary outcomes were the length of stay and cost. Results: A total of 19 studies met inclusion and exclusion criteria and included 3,387 patients. Meta-analysis showed a decrease in pancreatic fistula (OR = 0.79, 95% CI: 0.67 to 0.95; I 2 = 0%), infection (OR = 0.63, 95% CI: 0.50 to 0.78; I 2 = 0%), especially incision infection (OR = 0.62, 95% CI: 0.42 to 0.91; I 2 = 0%), and pulmonary infection (OR = 0.28, 95% CI: 0.12 to 0.66; I 2 = 0%). Length-of-stay (MD: −3.89 days, 95% CI: −4.98 to −2.81; I 2 = 78%) and cost were also significantly reduced. There was no significant increase in mortality, readmission, reoperation, or delayed gastric emptying. Conclusion: This analysis revealed that using ERAS protocols in pancreatic resections may help decrease the incidence of pancreatic fistula and infections. Furthermore, ERAS also reduces length of stay and cost of care. This study provides evidence for the benefit of ERAS protocols.

Background The purpose of this study was to perform a systematic review of the interventions for advanced non-small cell lung cancer (NSCLC) including chemotherapy alone and chemotherapy plus COX-2 inhibitors to identify and discuss the cause of any variation across studies and to explore the best currently available evidence. Methods The literature was comprehensively searched to identify relevant meta-analyses, and the Jadad decision algorithm was used to select the best evidence from the included meta-analyses. Quality assessment of the meta-analyses was performed using the Quality of Reporting (QUOROM) checklist and the Oxman-Guyatt quality index. Results Five meta-analyses were selected for inclusion in this study. Three were published prior to 2018 and had Oxman-Guyatt scores of 5. Only one study had the highest QUOROM and Oxman-Guyatt scores, and that study concluded that first-line treatment with chemotherapy plus COX-2 inhibitors was superior to chemotherapy alone in terms of the overall response rate (ORR). However, no significant difference in clinical benefit, progression-free survival (PFS), overall survival (OS), or 1-year survival rate was found. In addition, toxicities of the drugs had some influence on patients with heart disease. Conclusions The Jadad algorithm identified the optimal current meta-analysis. COX-2 inhibitors increased the ORR when combined with chemotherapy, but did not improve the survival indices. In addition, they may increase the risk of cardiovascular events and hematological toxicities in NSCLC patients.