Effect of fast track surgery in perioperative period of hepatectomy: A meta analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

PU Xiaojin ¹ , ZHANG Youdi ² , WANG Yuanyunzi ¹ ,  BAI Zhongtian ¹

1. Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, P. R. China;
2. The First Hospital of Lanzhou University, Lanzhou 730000, P. R. China;

Corresponding author：

BAI Zhongtian, Email: baizht07@lzu.edu.cn

Keywords：

hepatectomy; fast-track surgery; meta-analysis; safety; effectiveness

DOI：

10.7507/1007-9424.201911031

Video：

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Objective To systematically evaluate safety and effectiveness of using fast track surgery (FTS) protocol in perioperative management of hepatectomy. Methods The studies were collected by searching the PubMed, Web of Science, Cochrane Library, CNKI, Wanfang Data, and VIP databases by two researchers. The FTS management was used in the FTS group and the traditional perioperative management was used in the traditional group. The meta analysis was performed using the RevMan 5.3 software. Results A total of 28 articles were included in the study, of which 1 632 patients in the FTS group and 1 820 patients in the traditional group; 14 RCTs, 14 CCTs. The results of meta analysis showed: Compared with the traditional group, the FTS not only could reduce the pain of patients during 24 and 48 hours after the surgery [24 h: WMD=–0. 92, 95%CI (–1.05, –0.79), P<0.000 01; 48 h:WMD=–0.73, 95%CI (–0.90, –0.56), P<0.000 01], but also shorten the first postoperative flatus time of patients [WMD=–17.36, 95%CI (–23.16, –11.56), P<0.000 01] and the length of hospital stay [WMD=–2.42, 95%CI (–3.02, –1.63), P<0.000 01] and reduce the hos-pitalization expenses [WMD=–0.52, 95%CI (–0.64, –0.41, P<0.000 01]; While the incidences of pulmonary comp-lications [OR=0.51, 95%CI (0.32, 0.81), P=0.005], total complications [OR=0.57, 95%CI (0.38, 0.87), P=0.008], and nausea and vomiting [OR=0.45, 95%CI (0.31, 0.65), P<0.000 1] were significantly decreased. The RCT group and CCT group showed the same conclusions with the overall study (except incidence of postoperative pulmonary complications between the two groups in the CCT study). Conclusion For patients with elective hepatectomy, it seems feasible to use FTS protocol, which could promote postoperative bowel recovery, shorten length of hospital day, and save medical resources.

Citation： PU Xiaojin, ZHANG Youdi, WANG Yuanyunzi, BAI Zhongtian. Effect of fast track surgery in perioperative period of hepatectomy: A meta analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(9): 1128-1138. doi: 10.7507/1007-9424.201911031 Copy

1.	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
2.	Higgins JPT, Green S. (2011) Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. The Cochrane Collaboration. http://handbook-5-1.cochrane.org.
3.	Slim K, Nini E, Forestier D, et al. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg, 2003, 73(9): 712-716.
4.	侯晓雯, 时景璞, 陈欣, 等. 在 Meta 分析中如何利用中位数、极差和样本量估算均数、标准差. 中国循证医学杂志, 2015, 15(4): 484-487.
5.	胡捷, 樊嘉, 徐泱, 等. 加速康复外科技术对肝肿瘤患者术后恢复的影响. 中华消化外科杂志, 2009, 8(4): 281-283.
6.	彭浪, 邹书兵, 高崇茂, 等. 加速康复外科理念在原发性肝癌肝切除术围手术期管理的应用价值. 中国普通外科杂志, 2017, 26(2): 218-222.
7.	禹亚彬, 祁付珍, 陈亚, 等. 加速康复在老年肝切除围手术期的应用. 中华普通外科杂志, 2018, 33(8): 687-688.
8.	丁蔚, 张峰, 李国强, 等. 快速康复理念在肝癌肝切除术围手术期处理中的应用. 中国普通外科杂志, 2013, 22(1): 32-36.
9.	何国林, 洪合, 程远, 等. 快速康复外科理念在腹腔镜肝切除术中的应用. 中华普通外科杂志, 2018, 33(8): 635-637.
10.	首志雄, 郑达武, 罗永香, 等. 快速康复外科理念在肝癌肝切除术围手术期管理中的临床价值. 中华消化外科杂志, 2014, 13(6): 456-460.
11.	樊献军, 谭黄业, 肖咏梅, 等. 快速康复外科理念在肝癌围手术期处理中的应用. 中国普通外科杂志, 2011, 20(7): 683-686.
12.	戴丐国. 外科快速康复理念在老年人肝癌肝切除围术期处理中的应用. 中华老年医学杂志, 2014, 33(12): 1317-1319.
13.	He F, Lin X, Xie F, et al. The effect of enhanced recovery program for patients undergoing partial laparoscopic hepatectomy of liver cancer. Clin Transl Oncol, 2015, 17(9): 694-701.
14.	Jones C, Kelliher L, Dickinson M, et al. Randomized clinical trial on enhanced recovery versus standard care following open liver resection. Br J Surg, 2013, 100(8): 1015-1024.
15.	Liang X, Ying H, Wang H, et al. Enhanced recovery care versus traditional care after laparoscopic liver resections: a randomized controlled trial. Surg Endosc, 2018, 32(6): 2746-2757.
16.	Liang X, Ying H, Wang H, et al. Enhanced recovery program versus traditional care in laparoscopic hepatectomy. Medicine (Baltimore), 2016, 95(8): e2835.
17.	Ni CY, Yang Y, Chang YQ, et al. Fast-track surgery improves postoperative recovery in patients undergoing partial hepatectomy for primary liver cancer: A prospective randomized controlled trial. Eur J Surg Oncol, 2013, 39(6): 542-547.
18.	Qi S, Chen G, Cao P, et al. Safety and efficacy of enhanced recovery after surgery (ERAS) programs in patients undergoing hepatectomy: A prospective randomized controlled trial. J Clin Lab Anal, 2018, 32(6): e22434.
19.	严锦, 王瑞兰, 王继涛, 等. 基于快速康复外科理念的肝癌患者围术期护理流程应用. 护理学杂志, 2014, 29(16): 32-34.
20.	林德新, 李旋, 张勇, 等. 加速康复外科程序在肝胆管结石肝切除术中的应用. 中国普通外科杂志, 2018, 27(2): 169-174.
21.	余海波, 彭亚南, 董亚东, 等. 加速康复外科在腹腔镜精准肝切除中的应用价值. 中华普通外科杂志, 2018, 33(5): 401-404.
22.	王谦, 柏斗胜, 蒋国庆, 等. 加速康复外科在原发性肝癌根治术中的应用研究. 中华普通外科杂志, 2018, 33(8): 638-641.
23.	任春霞, 李伦兰, 丁萍, 等. 快速康复路径在原发性肝癌患者围手术期的应用. 中华疾病控制杂志, 2016, 20(6): 600-603, 608.
24.	徐春艳, 康璇, 杨丽红, 等. 医护一体化护理干预促进肝癌患者快速康复的效果. 解放军护理杂志, 2016, 33(24): 53-55.
25.	Chong CCN, Chung WY, Cheung YS, et al. Enhanced recovery after surgery for liver resection. Hong Kong Med J, 2019, 25(2): 94-101.
26.	Kaibori M, Matsui K, Ishizaki M, et al. Effects of implementing an "enhanced recovery after surgery" program on patients undergoing resection of hepatocellular carcinoma. Surg Today, 2017, 47(1): 42-51.
27.	Lin DX, Li X, Ye QW, et al. Implementation of a fast-track clinical pathway decreases postoperative length of stay and hospital charges for liver resection. Cell Biochem Biophys, 2011, 61(2): 413-419.
28.	Ovaere S, Boscart I, Parmentier I, et al. The effectiveness of a clinical pathway in liver surgery: a case-control study. J Gastrointest Surg, 2018, 22(4): 684-694.
29.	Page AJ, Gani F, Crowley KT, et al. Patient outcomes and provider perceptions following implementation of a standardized perioperative care pathway for open liver resection. Br J Surg, 2016, 103(5): 564-571.
30.	Savikko J, Ilmakunnas M, Mäkisalo H, et al. Enhanced recovery protocol after liver resection. Br J Surg, 2015, 102(12): 1526-1532.
31.	Stoot JH, van Dam RM, Busch OR, et al. The effect of a multimodal fast-track programme on outcomes in laparoscopic liver surgery: a multicentre pilot study. HPB (Oxford), 2009, 11(2): 140-144.
32.	van Dam RM, Hendry PO, Coolsen MM, et al. Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection. Br J Surg, 2008, 95(8): 969-975.
33.	苏艳, 任龙飞, 魏花萍, 等. 快速康复外科在开腹肝癌切除术中应用的 Meta 分析. 中国普通外科杂志, 2019, 28(2): 195-205.
34.	中华医学会外科学分会, 中华医学会麻醉学分会. 加速康复外科中国专家共识及路径管理指南 (2018 版). 中国实用外科杂志, 2018, 38(1): 1-20.
35.	朱财林, 傅涛, 蔡逊. 快速康复外科对根治性远端胃切除患者预后的影响. 现代肿瘤医学, 2016, 24(12): 1926-1930.
36.	Wu SJ, Xiong XZ, Lu J, et al. Fast-track programs for liver surgery: a meta-analysis. J Gastrointest Surg, 2015, 19(9): 1640-1652.
37.	唐曙光, 彭创, 赵畅, 等. 快速康复外科理念在肝癌肝切除围手术期应用的 Meta 分析. 医学临床研究, 2016, 33(4): 625-629.
38.	任秋平, 杨健, 罗艳丽. 改良快速康复流程在开腹肝脏部分切除术围手术期的应用. 华西医学, 2017, 32(5): 717-722.
39.	曹勤, 丁佑铭, 汪斌, 等. 加速康复外科理念在腹腔镜肝切除术治疗肝胆管结石病中的应用. 腹部外科, 2018, 31(5): 332-336.
40.	Jing X, Zhang B, Xing S, et al. Cost-benefit analysis of enhanced recovery after hepatectomy in Chinese Han population. Medicine (Baltimore), 2018, 97(34): e11957.
41.	Sutherasan M, Taesombat W, Sirichindakul B, et al. Improving the surgical outcomes after liver resection with ERAS program. J Med Assoc Thai, 2017, 100(4): 435-440.
42.	Song W, Wang K, Zhang RJ, et al. The enhanced recovery after surgery (ERAS) program in liver surgery: a meta-analysis of randomized controlled trials. Springerplus, 2016, 5: 207.

1. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
2. Higgins JPT, Green S. (2011) Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. The Cochrane Collaboration. http://handbook-5-1.cochrane.org.
3. Slim K, Nini E, Forestier D, et al. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg, 2003, 73(9): 712-716.
4. 侯晓雯, 时景璞, 陈欣, 等. 在 Meta 分析中如何利用中位数、极差和样本量估算均数、标准差. 中国循证医学杂志, 2015, 15(4): 484-487.
5. 胡捷, 樊嘉, 徐泱, 等. 加速康复外科技术对肝肿瘤患者术后恢复的影响. 中华消化外科杂志, 2009, 8(4): 281-283.
6. 彭浪, 邹书兵, 高崇茂, 等. 加速康复外科理念在原发性肝癌肝切除术围手术期管理的应用价值. 中国普通外科杂志, 2017, 26(2): 218-222.
7. 禹亚彬, 祁付珍, 陈亚, 等. 加速康复在老年肝切除围手术期的应用. 中华普通外科杂志, 2018, 33(8): 687-688.
8. 丁蔚, 张峰, 李国强, 等. 快速康复理念在肝癌肝切除术围手术期处理中的应用. 中国普通外科杂志, 2013, 22(1): 32-36.
9. 何国林, 洪合, 程远, 等. 快速康复外科理念在腹腔镜肝切除术中的应用. 中华普通外科杂志, 2018, 33(8): 635-637.
10. 首志雄, 郑达武, 罗永香, 等. 快速康复外科理念在肝癌肝切除术围手术期管理中的临床价值. 中华消化外科杂志, 2014, 13(6): 456-460.
11. 樊献军, 谭黄业, 肖咏梅, 等. 快速康复外科理念在肝癌围手术期处理中的应用. 中国普通外科杂志, 2011, 20(7): 683-686.
12. 戴丐国. 外科快速康复理念在老年人肝癌肝切除围术期处理中的应用. 中华老年医学杂志, 2014, 33(12): 1317-1319.
13. He F, Lin X, Xie F, et al. The effect of enhanced recovery program for patients undergoing partial laparoscopic hepatectomy of liver cancer. Clin Transl Oncol, 2015, 17(9): 694-701.
14. Jones C, Kelliher L, Dickinson M, et al. Randomized clinical trial on enhanced recovery versus standard care following open liver resection. Br J Surg, 2013, 100(8): 1015-1024.
15. Liang X, Ying H, Wang H, et al. Enhanced recovery care versus traditional care after laparoscopic liver resections: a randomized controlled trial. Surg Endosc, 2018, 32(6): 2746-2757.
16. Liang X, Ying H, Wang H, et al. Enhanced recovery program versus traditional care in laparoscopic hepatectomy. Medicine (Baltimore), 2016, 95(8): e2835.
17. Ni CY, Yang Y, Chang YQ, et al. Fast-track surgery improves postoperative recovery in patients undergoing partial hepatectomy for primary liver cancer: A prospective randomized controlled trial. Eur J Surg Oncol, 2013, 39(6): 542-547.
18. Qi S, Chen G, Cao P, et al. Safety and efficacy of enhanced recovery after surgery (ERAS) programs in patients undergoing hepatectomy: A prospective randomized controlled trial. J Clin Lab Anal, 2018, 32(6): e22434.
19. 严锦, 王瑞兰, 王继涛, 等. 基于快速康复外科理念的肝癌患者围术期护理流程应用. 护理学杂志, 2014, 29(16): 32-34.
20. 林德新, 李旋, 张勇, 等. 加速康复外科程序在肝胆管结石肝切除术中的应用. 中国普通外科杂志, 2018, 27(2): 169-174.
21. 余海波, 彭亚南, 董亚东, 等. 加速康复外科在腹腔镜精准肝切除中的应用价值. 中华普通外科杂志, 2018, 33(5): 401-404.
22. 王谦, 柏斗胜, 蒋国庆, 等. 加速康复外科在原发性肝癌根治术中的应用研究. 中华普通外科杂志, 2018, 33(8): 638-641.
23. 任春霞, 李伦兰, 丁萍, 等. 快速康复路径在原发性肝癌患者围手术期的应用. 中华疾病控制杂志, 2016, 20(6): 600-603, 608.
24. 徐春艳, 康璇, 杨丽红, 等. 医护一体化护理干预促进肝癌患者快速康复的效果. 解放军护理杂志, 2016, 33(24): 53-55.
25. Chong CCN, Chung WY, Cheung YS, et al. Enhanced recovery after surgery for liver resection. Hong Kong Med J, 2019, 25(2): 94-101.
26. Kaibori M, Matsui K, Ishizaki M, et al. Effects of implementing an "enhanced recovery after surgery" program on patients undergoing resection of hepatocellular carcinoma. Surg Today, 2017, 47(1): 42-51.
27. Lin DX, Li X, Ye QW, et al. Implementation of a fast-track clinical pathway decreases postoperative length of stay and hospital charges for liver resection. Cell Biochem Biophys, 2011, 61(2): 413-419.
28. Ovaere S, Boscart I, Parmentier I, et al. The effectiveness of a clinical pathway in liver surgery: a case-control study. J Gastrointest Surg, 2018, 22(4): 684-694.
29. Page AJ, Gani F, Crowley KT, et al. Patient outcomes and provider perceptions following implementation of a standardized perioperative care pathway for open liver resection. Br J Surg, 2016, 103(5): 564-571.
30. Savikko J, Ilmakunnas M, Mäkisalo H, et al. Enhanced recovery protocol after liver resection. Br J Surg, 2015, 102(12): 1526-1532.
31. Stoot JH, van Dam RM, Busch OR, et al. The effect of a multimodal fast-track programme on outcomes in laparoscopic liver surgery: a multicentre pilot study. HPB (Oxford), 2009, 11(2): 140-144.
32. van Dam RM, Hendry PO, Coolsen MM, et al. Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection. Br J Surg, 2008, 95(8): 969-975.
33. 苏艳, 任龙飞, 魏花萍, 等. 快速康复外科在开腹肝癌切除术中应用的 Meta 分析. 中国普通外科杂志, 2019, 28(2): 195-205.
34. 中华医学会外科学分会, 中华医学会麻醉学分会. 加速康复外科中国专家共识及路径管理指南 (2018 版). 中国实用外科杂志, 2018, 38(1): 1-20.
35. 朱财林, 傅涛, 蔡逊. 快速康复外科对根治性远端胃切除患者预后的影响. 现代肿瘤医学, 2016, 24(12): 1926-1930.
36. Wu SJ, Xiong XZ, Lu J, et al. Fast-track programs for liver surgery: a meta-analysis. J Gastrointest Surg, 2015, 19(9): 1640-1652.
37. 唐曙光, 彭创, 赵畅, 等. 快速康复外科理念在肝癌肝切除围手术期应用的 Meta 分析. 医学临床研究, 2016, 33(4): 625-629.
38. 任秋平, 杨健, 罗艳丽. 改良快速康复流程在开腹肝脏部分切除术围手术期的应用. 华西医学, 2017, 32(5): 717-722.
39. 曹勤, 丁佑铭, 汪斌, 等. 加速康复外科理念在腹腔镜肝切除术治疗肝胆管结石病中的应用. 腹部外科, 2018, 31(5): 332-336.
40. Jing X, Zhang B, Xing S, et al. Cost-benefit analysis of enhanced recovery after hepatectomy in Chinese Han population. Medicine (Baltimore), 2018, 97(34): e11957.
41. Sutherasan M, Taesombat W, Sirichindakul B, et al. Improving the surgical outcomes after liver resection with ERAS program. J Med Assoc Thai, 2017, 100(4): 435-440.
42. Song W, Wang K, Zhang RJ, et al. The enhanced recovery after surgery (ERAS) program in liver surgery: a meta-analysis of randomized controlled trials. Springerplus, 2016, 5: 207.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of fast track surgery in perioperative period of hepatectomy: A meta analysis

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