Meta-Analysis
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World J Gastroenterol. Jan 14, 2014; 20(2): 578-583
Published online Jan 14, 2014. doi: 10.3748/wjg.v20.i2.578
Fast-track program vs traditional care in surgery for gastric cancer
Zhi-Xing Chen, Ae-Huey Jennifer Liu, Ying Cen
Zhi-Xing Chen, Ae-Huey Jennifer Liu, Ying Cen, Department of Burns and Plastic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Chen ZX and Cen Y designed the study and wrote the manuscript; Chen ZX conducted the statistical analysis; Chen ZX, Liu AHJ and Cen Y wrote the manuscript.
Correspondence to: Ying Cen, Professor, Department of Burns and Plastic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China. czx116633@163.com
Telephone: +86-28-85422679 Fax: +86-28-85422364
Received: June 17, 2013
Revised: October 18, 2013
Accepted: October 19, 2013
Published online: January 14, 2014
Processing time: 216 Days and 1.3 Hours
Abstract

AIM: To systematically review the evidence for the effectiveness of fast-track program vs traditional care in laparoscopic or open surgery for gastric cancer.

METHODS: PubMed, Embase and the Cochrane library databases were electronically searched for published studies between January 1995 and April 2013, and only randomized trials were included. The references of relevant studies were manually searched for further studies that may have been missed. Search terms included “gastric cancer”, “fast track” and “enhanced recovery”. Five outcome variables were considered most suitable for analysis: postoperative hospital stay, medical cost, duration to first flatus, C-reactive protein (CRP) level and complications. Postoperative hospital stay was calculated from the date of operation to the date of discharge. Fixed effects model was used for meta-analysis.

RESULTS: Compared with traditional care, fast-track program could significantly decrease the postoperative hospital stay [weighted mean difference (WMD) = -1.19, 95%CI: -1.79--0.60, P = 0.0001, fixed model], duration to first flatus (WMD = -6.82, 95%CI: -11.51--2.13, P = 0.004), medical costs (WMD = -2590, 95%CI: -4054--1126, P = 0.001), and the level of CRP (WMD = -17.78, 95%CI: -32.22--3.35, P = 0.0001) in laparoscopic surgery for gastric cancer. In open surgery for gastric cancer, fast-track program could also significantly decrease the postoperative hospital stay (WMD = -1.99, 95%CI: -2.09--1.89, P = 0.0001), duration to first flatus (WMD = -12.0, 95%CI: -18.89--5.11, P = 0.001), medical cost (WMD = -3674, 95%CI: -5025--2323, P = 0.0001), and the level of CRP (WMD = -27.34, 95%CI: -35.42--19.26, P = 0.0001). Furthermore, fast-track program did not significantly increase the incidence of complication (RR = 1.39, 95%CI: 0.77-2.51, P = 0.27, for laparoscopic surgery; and RR = 1.52, 95%CI: 0.90-2.56, P = 0.12, for open surgery).

CONCLUSION: Our overall results suggested that compared with traditional care, fast-track program could result in shorter postoperative hospital stay, less medical costs, and lower level of CRP, with no more complications occurring in both laparoscopic and open surgery for gastric cancer.

Keywords: Fast-track program; Traditional care; Gastric cancer; Meta-analysis; Laparoscopic and open surgery

Core tip: Our overall results suggested that compared with traditional care, fast-track program could result in shorter postoperative hospital stay, less medical cost, and lower level of C-reactive protein, with no more complications occurring in both laparoscopic and open surgery for gastric cancer.