Enhanced recovery pathways vs standard care pathways in esophageal cancer surgery: systematic review and meta-analysis

AbstractEnhanced recovery after surgery (ERAS) protocols vs standard care pathways after esophagectomy for malignancy have gained wide popularity among surgeons. However, the current literature is still lacking level-I evidence to show a clear superiority of one approach. The present study is a detailed systematic review and meta-analysis of the published trials. A systematic review of literature databases was conducted for randomized controlled trials (RCTs) and non-randomized, prospective, comparative studies between January 1990 and September 2019, comparing ERAS pathway group with standard care for esophageal resection for esophageal cancer. Mean difference (MD) for continuous variables and odds ratio (OR) or risk difference (RD) for dichotomous variables with 95% confidence interval (CI) were used. Between-study heterogeneity was evaluated. Eight studies with a total of 1133 patients were included. Hospital stay [Standard mean difference (Std. MD)  = − 1.92, 95% CI − 2.78, − 1.06,P <  0.0001], overall morbidity (OR 0.68, CI 0.49, 0.96,P = 0.03), pulmonary complications (OR 0.45, CI 0.31, 0.65,P <  0.0001), anastomotic leak rate (OR 0.37, CI 0.18, 0.74,P = 0.005), time to first flatus and defecation (Std. MD = -5.01, CI − 9.53, − 0.49,P = 0.03), (Std. MD = − 1.36, CI − 1.78, − 0.94,P <  0.00001) and total hospital cost (Std. MD = − 1.62, CI − 2.24, − 1.01,P <  0.00001) favored the ERA...
Source: Esophagus - Category: Gastroenterology Source Type: research