Systematic Review and Meta-Analysis of the Efficacy and Safety of Enhanced Recovery After Surgery vs. Conventional Recovery After Surgery on Perioperative Outcomes of Radical Cystectomy
Background and objective: Radical cystectomy has been characterized as the most difficult operation in urology because of the complex surgical procedures and postoperative complications. Enhanced recovery after surgery (ERAS), which reduces the incidence of perioperative complications, has been wide...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-09-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fonc.2020.541390/full |
| _version_ | 1818159193078628352 |
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| author | Dongxu Zhang Kai Sun Tianqi Wang Gang Wu Jipeng Wang Yuanshan Cui Yuanshan Cui Jitao Wu |
| author_facet | Dongxu Zhang Kai Sun Tianqi Wang Gang Wu Jipeng Wang Yuanshan Cui Yuanshan Cui Jitao Wu |
| author_sort | Dongxu Zhang |
| collection | DOAJ |
| description | Background and objective: Radical cystectomy has been characterized as the most difficult operation in urology because of the complex surgical procedures and postoperative complications. Enhanced recovery after surgery (ERAS), which reduces the incidence of perioperative complications, has been widely used in clinical surgery. Herein, we performed a meta-analysis to evaluate the efficacy and safety of ERAS vs. conventional recovery after surgery (CRAS) on perioperative outcomes of radical cystectomy.Methods: We performed a systematic search of randomized controlled trials (RCTs) in the following databases: Medline, Embase, and the Cochrane Controlled Trials Register, based on the PICOS strategy. The reference lists of the retrieved studies were further surveyed for relevant publications.Results: Our search yielded seven RCTs containing 813 patients. The ERAS group was found to have better performance in the following parameters: length of hospital stay [mean difference (MD) = −1.12, 95% confidence interval (CI): −1.80 to −0.45, P = 0.001], time to first flatus (MD = −0.70, 95% CI: −0.98 to 0.41, P < 0.00001), and time to regular diet (MD = −0.12, 95% CI: −1.76 to −0.28, P = 0.007). However, there were no significant differences between the two groups in major complications [odds ratio (OR) = 0.91, 95% CI: 0.63 to 1.34, P = 0.64], readmission (OR = 1.15, 95% CI: 0.65 to 2.01, P = 0.63), ileus (OR = 0.75, 95% CI: 0.44 to 1.28, P = 0.29), wound infection (OR = 0.56, 95% CI: 0.31 to 1.01, P = 0.05), mortality (OR = 0.69, 95% CI: 0.24 to 1.99, P = 0.49), or time to first bowel movement (MD = −0.55, 95% CI: −1.62 to 0.53, P = 0.32).Conclusion: ERAS reduced the length of hospital stay, time to first flatus, and time to regular diet after cystectomy. Compared to CRAS protocols, ERAS protocols do not increase the risk of adverse events. |
| first_indexed | 2024-12-11T15:42:05Z |
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| id | doaj.art-47cf06bae53a4a68ada743437d1d7fb8 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-11T15:42:05Z |
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| series | Frontiers in Oncology |
| spelling | doaj.art-47cf06bae53a4a68ada743437d1d7fb82022-12-22T00:59:47ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2020-09-011010.3389/fonc.2020.541390541390Systematic Review and Meta-Analysis of the Efficacy and Safety of Enhanced Recovery After Surgery vs. Conventional Recovery After Surgery on Perioperative Outcomes of Radical CystectomyDongxu Zhang0Kai Sun1Tianqi Wang2Gang Wu3Jipeng Wang4Yuanshan Cui5Yuanshan Cui6Jitao Wu7Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, ChinaDepartment of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, ChinaDepartment of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, ChinaDepartment of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, ChinaDepartment of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, ChinaDepartment of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, ChinaDepartment of Urology, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, ChinaBackground and objective: Radical cystectomy has been characterized as the most difficult operation in urology because of the complex surgical procedures and postoperative complications. Enhanced recovery after surgery (ERAS), which reduces the incidence of perioperative complications, has been widely used in clinical surgery. Herein, we performed a meta-analysis to evaluate the efficacy and safety of ERAS vs. conventional recovery after surgery (CRAS) on perioperative outcomes of radical cystectomy.Methods: We performed a systematic search of randomized controlled trials (RCTs) in the following databases: Medline, Embase, and the Cochrane Controlled Trials Register, based on the PICOS strategy. The reference lists of the retrieved studies were further surveyed for relevant publications.Results: Our search yielded seven RCTs containing 813 patients. The ERAS group was found to have better performance in the following parameters: length of hospital stay [mean difference (MD) = −1.12, 95% confidence interval (CI): −1.80 to −0.45, P = 0.001], time to first flatus (MD = −0.70, 95% CI: −0.98 to 0.41, P < 0.00001), and time to regular diet (MD = −0.12, 95% CI: −1.76 to −0.28, P = 0.007). However, there were no significant differences between the two groups in major complications [odds ratio (OR) = 0.91, 95% CI: 0.63 to 1.34, P = 0.64], readmission (OR = 1.15, 95% CI: 0.65 to 2.01, P = 0.63), ileus (OR = 0.75, 95% CI: 0.44 to 1.28, P = 0.29), wound infection (OR = 0.56, 95% CI: 0.31 to 1.01, P = 0.05), mortality (OR = 0.69, 95% CI: 0.24 to 1.99, P = 0.49), or time to first bowel movement (MD = −0.55, 95% CI: −1.62 to 0.53, P = 0.32).Conclusion: ERAS reduced the length of hospital stay, time to first flatus, and time to regular diet after cystectomy. Compared to CRAS protocols, ERAS protocols do not increase the risk of adverse events.https://www.frontiersin.org/article/10.3389/fonc.2020.541390/fullmeta-analysisradical cystectomyERAS (enhanced recovery after surgery)CRAsRCT—randomized controlled trial |
| spellingShingle | Dongxu Zhang Kai Sun Tianqi Wang Gang Wu Jipeng Wang Yuanshan Cui Yuanshan Cui Jitao Wu Systematic Review and Meta-Analysis of the Efficacy and Safety of Enhanced Recovery After Surgery vs. Conventional Recovery After Surgery on Perioperative Outcomes of Radical Cystectomy Frontiers in Oncology meta-analysis radical cystectomy ERAS (enhanced recovery after surgery) CRAs RCT—randomized controlled trial |
| title | Systematic Review and Meta-Analysis of the Efficacy and Safety of Enhanced Recovery After Surgery vs. Conventional Recovery After Surgery on Perioperative Outcomes of Radical Cystectomy |
| title_full | Systematic Review and Meta-Analysis of the Efficacy and Safety of Enhanced Recovery After Surgery vs. Conventional Recovery After Surgery on Perioperative Outcomes of Radical Cystectomy |
| title_fullStr | Systematic Review and Meta-Analysis of the Efficacy and Safety of Enhanced Recovery After Surgery vs. Conventional Recovery After Surgery on Perioperative Outcomes of Radical Cystectomy |
| title_full_unstemmed | Systematic Review and Meta-Analysis of the Efficacy and Safety of Enhanced Recovery After Surgery vs. Conventional Recovery After Surgery on Perioperative Outcomes of Radical Cystectomy |
| title_short | Systematic Review and Meta-Analysis of the Efficacy and Safety of Enhanced Recovery After Surgery vs. Conventional Recovery After Surgery on Perioperative Outcomes of Radical Cystectomy |
| title_sort | systematic review and meta analysis of the efficacy and safety of enhanced recovery after surgery vs conventional recovery after surgery on perioperative outcomes of radical cystectomy |
| topic | meta-analysis radical cystectomy ERAS (enhanced recovery after surgery) CRAs RCT—randomized controlled trial |
| url | https://www.frontiersin.org/article/10.3389/fonc.2020.541390/full |
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