Fast-track surgery could improve postoperative recovery in radical total gastrectomy patients

Feng, Fan; Ji, Gang; Li, Jipeng; Li, Xiaohua; Shi, Hai; Zhao, Zhengwei; Wu, Guosheng; Liu, Xiao‐Nan; Zhao, Qingchuan

doi:10.3748/wjg.v19.i23.3642

Cited by 81 publications

(113 citation statements)

References 35 publications

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“…In this review, studies investigating the cost as either a primary or secondary outcome have been conducted in Europe, [7][8][9][10][11][12] Asia, [13][14][15][16][17][18] North America, 2,19 USA, 20 and Australasia. 1,21 Six of the 17 studies were systematic reviews.…”

Section: Resultsmentioning

confidence: 99%

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Health economics in Enhanced Recovery After Surgery programs

Stowers

Lemanu

Hill

2014

Can J Anesth/J Can Anesth

134

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Purpose The Enhanced Recovery After Surgery (ERAS) program aims to combine and coordinate evidence-based perioperative care interventions that support standardizing and optimizing surgical care. In conjunction with its clinical benefits, it has been suggested that ERAS reduces costs through shorter convalescence and reduced morbidity. Nevertheless, few studies have evaluated the cost-effectiveness of ERAS programs. The aim of this systematic review, therefore, is to evaluate the claims that ERAS is cost-effective and to characterize how these costs were reported and evaluated. Source The electronic databases, MEDLINE Ò and EMBASE TM , were searched from inception to April 2014. Principal findings Seventeen studies met the inclusion criteria and were included for review. Enhanced Recovery After Surgery protocols in various abdominal surgeries have been investigated, including colorectal, bariatric, gynecological, gastric, pancreatic, esophageal, and vascular surgery. All studies reported cost savings associated with hastening recovery and reducing morbidity and complications. All studies included in this review focused primarily on in-hospital costs, with some attempting to account for readmission costs and follow-up services. In all but two studies, the breakdown of cost data for the individual studies was poorly detailed. Conclusions In conclusion, ERAS protocols appear to be both clinically efficacious and cost effective across a variety of surgical specialties in the short term. Nevertheless, studies reporting out-of-hospital cost data are lacking. Further research is required to determine how best to evaluate both medium-and long-term costs relating to ERAS pathways while taking quality of life data into account. RésuméObjectif Le programme de Récupération rapide après la chirurgie (RRAC) vise à combiner et coordonner des interventions de soins périopératoires basées sur des données probantes qui soutiennent la standardisation et l'optimisation des soins chirurgicaux. En association avec ses avantages cliniques, il a été suggéré que la RRAC réduisait les coûts grâce à une convalescence raccourcie et une moindre morbidité. Néanmoins, peu d'études ont évalué le rapport efficacité-coût des programmes de RRAC. Le but de cette synthèse systématique est donc d'évaluer l'argument de rentabilité de la RRAC et de préciser dans quelle mesure ces coûts ont été rapportés et évalués. Sources Une recherche a été menée dans les bases de données électroniques MEDLINE Ò et EMBASE TM depuis les origines du concept jusqu'en avril 2014. Constatations principales Dix-sept études répondaient aux critères d'inclusion et ont été analysées. Les protocoles de Récupération rapide après la chirurgie concernant différentes interventions chirurgicales abdominales (colorectales, bariatriques, gynécologiques, gastriques, pancréatiques, oesophagiennes et vasculaires) ont été étudiés. Toutes les études rapportaient des économies associées à l'accélération de la récupération et à la réduction de la morbidité et des complications. Tout...

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Section: Resultsmentioning

confidence: 99%

“…One hundred nineteen patients were randomized to either an ERAS group (n = 59) or a conventional care group (n = 60). 16 Investigators reported significant reductions in time to flatus and defecation, pain scores, complications, and costs (P \ 0.05).…”

Section: Gastric Surgerymentioning

confidence: 99%

Health economics in Enhanced Recovery After Surgery programs

Stowers

Lemanu

Hill

2014

Can J Anesth/J Can Anesth

134

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“…There were 11 articles (1,128 patients) on fast track oesophageal surgery [11][12][13][14][15][16][17][18][19][20][21] and 7 (329 patients) on fast track gastric surgery. 12,[22][23][24][25][26][27] Ten articles were case series, five were case-controlled studies and three were RCTs (all gastrectomy related with a Jadad score of 1 or 2). All articles involved single centre data, most being small volume.…”

Section: Resultsmentioning

confidence: 99%

“…The quality of included studies is generally poor, many are retrospective and there were only three RCTs, all single centre 22,23,25 with only one blinded. 22 The maximum number per arm in any of the studies was 61 patients and all excluded those undergoing neoadjuvant chemo or radiotherapy. Restricting our review to the English language literature may have led to the omission of some studies but this is unlikely to have influenced our summary outcome estimates.…”

Section: Limitationsmentioning

confidence: 99%

Systematic review of enhanced recovery after gastro-oesophageal cancer surgery

Gemmill

Humes

Catton

2015

annals

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INTRODUCTION Fast track methodology or enhanced recovery schemes have gained increasing popularity in perioperative care. While evidence is strong for colorectal surgery, its importance in gastric and oesophageal surgery has yet to be established. This article reviews the evidence of enhanced recovery schemes on outcome for this type of surgery. METHODS A systematic literature search was conducted up to March 2014. Studies were retrieved and analysed using predetermined criteria. RESULTS From 34 articles reviewed, 18 eligible studies were identified: 7 on gastric and 11 on oesophageal resection. Three randomised controlled trials, five case-controlled studies and ten case series were identified. The reported protocols included changes to each stage of the patient journey from pre to postoperative care. The specific focus following oesophageal resections was on early mobilisation, a reduction in intensive care unit stay, early drain removal and early (or no) contrast swallow studies. Following gastric resections, the emphasis was on reducing epidural anaesthesia along with re-establishing oral intake in the first three postoperative days and early removal of nasogastric tubes. In the papers reviewed, mortality rates following fast track surgery were 0.8% (9/1,075) for oesophageal resection and 0% (0/329) for gastric resection. The reported morbidity rate was 16.5% (54/329) following gastric resection and 38.6% (396/1,075) following oesophageal resection. Length of stay was reduced in both groups compared with conventional recovery groups in comparative studies. CONCLUSIONS The evidence for enhanced recovery schemes following gastric and oesophageal resection is weak, with only three (low volume) published randomised controlled trials. However, the enhanced recovery approach appears safe and may be associated with a reduction in length of stay.

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“…Although some reports have described the use of the ERAS protocol for patients undergoing surgery for gastric cancer, clear and convincing evidence for the usefulness of this protocol for such patients has not been established [15][16][17][18][19][20][21][22]. Consensus guidelines for enhanced recovery after gastrectomy have been published [23].…”

Section: Introductionmentioning

confidence: 99%

Protocol for enhanced recovery after surgery improves short-term outcomes for patients with gastric cancer: a randomized clinical trial

et al. 2017

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Background The feasibility of the use of the enhanced recovery after surgery (ERAS) protocol in patients with gastric cancer remains unclear. Methods This study was a single-center, prospective randomized trial involving patients with gastric cancer undergoing curative gastrectomy. The primary end point was the length of postoperative hospital stay. Secondary end points were the postoperative complication rate, admission costs, weight loss, and amount of physical activity. Results From July 2013 to June 2015, we randomized 148 patients into an ERAS protocol group (n = 73) and a conventional protocol group (n = 69); six patients withdrew from the study. The hospital stay was significantly shorter in the ERAS protocol group than in the conventional protocol group (9 days vs 10 days; P = 0.037). The ERAS protocol group had a significantly lower rate of postoperative complications of grade III or higher (4.1% vs 15.4%; P = 0.042) and reduced costs of hospitalization (JPY 1,462,766 vs JPY 1,493,930; P = 0.045). The ratio of body weight to preoperative weight at 1 week and 1 month after the operation was higher in the ERAS protocol group (0.962 vs 0.957, P = 0.020, and 0.951 vs 0.937, P = 0.021, respectively). The ERAS protocol group recorded more physical activity in the first week after surgery.Conclusions The ERAS protocol is safe and efficient, and seems to improve the postoperative course of patients with gastric cancer.

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Fast-track surgery could improve postoperative recovery in radical total gastrectomy patients

Abstract: FTS could be safely applied in radical total gastrectomy to accelerate clinical recovery of gastric cancer patients.

Cited by 81 publications

References 35 publications

Health economics in Enhanced Recovery After Surgery programs

Health economics in Enhanced Recovery After Surgery programs

Systematic review of enhanced recovery after gastro-oesophageal cancer surgery

Protocol for enhanced recovery after surgery improves short-term outcomes for patients with gastric cancer: a randomized clinical trial

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