ABSTRACT
AIM: To evaluate the impact of enhanced recovery after surgery (ERAS) programs in comparison with traditional care on liver surgery outcomes. METHODS: The PubMed, EMBASE, CNKI and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials (RCTs) comparing the ERAS program with traditional care in patients undergoing liver surgery. Studies selected for the meta-analysis met all of the following inclusion criteria: (1) evaluation of ERAS in comparison to traditional care in adult patients undergoing elective open or laparoscopic liver surgery; (2) outcome measures including complications, recovery of bowel function, and hospital length of stay; and (3) RCTs. The following exclusion criteria were applied: (1) the study was not an RCT; (2) the study did not compare ERAS with traditional care; (3) the study reported on emergency, non-elective or transplantation surgery; and (4) the study consisted of unpublished studies with only the abstract presented at a national or international meeting. The primary outcomes were complications. Secondary outcomes were length of hospital stay and time to first flatus. RESULTS: Five RCTs containing 723 patients were included in the meta-analysis. In 10/723 cases, patients presented with benign diseases, while the remaining 713 cases had liver cancer. Of the five studies, three were published in English and two were published in Chinese. Three hundred and fifty-four patients were in the ERAS group, while 369 patients were in the traditional care group. Compared with traditional care, ERAS programs were associated with significantly decreased overall complications (RR = 0.66; 95%CI: 0.49-0.88; P = 0.005), grade I complications (RR = 0.51; 95%CI: 0.33-0.79; P = 0.003), and hospital length of stay [WMD = -2.77 d, 95%CI: -3.87-(-1.66); P < 0.00001]. Similarly, ERAS programs were associated with decreased time to first flatus [WMD = -19.69 h, 95%CI: -34.63-(-4.74); P < 0.0001]. There was no statistically significant difference in grade II-V complications between the two groups. CONCLUSION: ERAS is a safe and effective program in liver surgery. Future studies should define the active elements to optimize postoperative outcomes for liver surgery.
Subject(s)
Hepatectomy , Perioperative Care/methods , Chi-Square Distribution , Flatulence , Hepatectomy/adverse effects , Humans , Length of Stay , Odds Ratio , Perioperative Care/adverse effects , Postoperative Complications/etiology , Program Evaluation , Randomized Controlled Trials as Topic , Recovery of Function , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
OBJECTIVE: The objectives of this review are to compare the effectiveness and safety of radiochemotherapy (RTCT) with radiotherapy (RT) alone in locally advanced cervical cancer (LACC). DATA SOURCES: We comprehensively searched the Cochrane library, Medline, EMBASE, Chinese biomedicine literature database, Chinese scientific full-text database and Chinese journal full-text database for relevant articles. The computer search was supplemented with a manual search of reference lists for all available review articles. Also reference lists of the included studies were reviewed. RESULTS: We included 18 randomized trials involving 3,517 patients. Meta-analysis results are as follows: the response rate, 3 and 5-year survival rates were significantly better in patients in the RTCT group than in RT group. As adverse effects, limited evidence suggests that there was no significant difference between the two groups with regard to rectitis, cystitis, nausea and vomiting. But RTCT group has higher incidence rates than RT group in gastrointestinal, myelosuppression and leucopenia. CONCLUSION: The combination of radiotherapy and chemotherapy was more effective for LACC than radiotherapy alone. There was no significant difference between the RTCT regimen group and RT regimen group with regard to adverse effects.
