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.	侯曉雯, 時景璞, 陳欣, 等. 在 Meta 分析中如何利用中位數、極差和樣本量估算均數、標準差. 中國循證醫學雜志, 2015, 15(4): 484-487.
5.	胡捷, 樊嘉, 徐泱, 等. 加速康復外科技術對肝腫瘤患者術后恢復的影響. 中華消化外科雜志, 2009, 8(4): 281-283.
6.	彭浪, 鄒書兵, 高崇茂, 等. 加速康復外科理念在原發性肝癌肝切除術圍手術期管理的應用價值. 中國普通外科雜志, 2017, 26(2): 218-222.
7.	禹亞彬, 祁付珍, 陳亞, 等. 加速康復在老年肝切除圍手術期的應用. 中華普通外科雜志, 2018, 33(8): 687-688.
8.	丁蔚, 張峰, 李國強, 等. 快速康復理念在肝癌肝切除術圍手術期處理中的應用. 中國普通外科雜志, 2013, 22(1): 32-36.
9.	何國林, 洪合, 程遠, 等. 快速康復外科理念在腹腔鏡肝切除術中的應用. 中華普通外科雜志, 2018, 33(8): 635-637.
10.	首志雄, 鄭達武, 羅永香, 等. 快速康復外科理念在肝癌肝切除術圍手術期管理中的臨床價值. 中華消化外科雜志, 2014, 13(6): 456-460.
11.	樊獻軍, 譚黃業, 肖詠梅, 等. 快速康復外科理念在肝癌圍手術期處理中的應用. 中國普通外科雜志, 2011, 20(7): 683-686.
12.	戴丐國. 外科快速康復理念在老年人肝癌肝切除圍術期處理中的應用. 中華老年醫學雜志, 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.	嚴錦, 王瑞蘭, 王繼濤, 等. 基于快速康復外科理念的肝癌患者圍術期護理流程應用. 護理學雜志, 2014, 29(16): 32-34.
20.	林德新, 李旋, 張勇, 等. 加速康復外科程序在肝膽管結石肝切除術中的應用. 中國普通外科雜志, 2018, 27(2): 169-174.
21.	余海波, 彭亞南, 董亞東, 等. 加速康復外科在腹腔鏡精準肝切除中的應用價值. 中華普通外科雜志, 2018, 33(5): 401-404.
22.	王謙, 柏斗勝, 蔣國慶, 等. 加速康復外科在原發性肝癌根治術中的應用研究. 中華普通外科雜志, 2018, 33(8): 638-641.
23.	任春霞, 李倫蘭, 丁萍, 等. 快速康復路徑在原發性肝癌患者圍手術期的應用. 中華疾病控制雜志, 2016, 20(6): 600-603, 608.
24.	徐春艷, 康璇, 楊麗紅, 等. 醫護一體化護理干預促進肝癌患者快速康復的效果. 解放軍護理雜志, 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, M?kisalo 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.	蘇艷, 任龍飛, 魏花萍, 等. 快速康復外科在開腹肝癌切除術中應用的 Meta 分析. 中國普通外科雜志, 2019, 28(2): 195-205.
34.	中華醫學會外科學分會, 中華醫學會麻醉學分會. 加速康復外科中國專家共識及路徑管理指南 (2018 版). 中國實用外科雜志, 2018, 38(1): 1-20.
35.	朱財林, 傅濤, 蔡遜. 快速康復外科對根治性遠端胃切除患者預后的影響. 現代腫瘤醫學, 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, 彭創, 趙暢, 等. 快速康復外科理念在肝癌肝切除圍手術期應用的 Meta 分析. 醫學臨床研究, 2016, 33(4): 625-629.
38.	任秋平, 楊健, 羅艷麗. 改良快速康復流程在開腹肝臟部分切除術圍手術期的應用. 華西醫學, 2017, 32(5): 717-722.
39.	曹勤, 丁佑銘, 汪斌, 等. 加速康復外科理念在腹腔鏡肝切除術治療肝膽管結石病中的應用. 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. 侯曉雯, 時景璞, 陳欣, 等. 在 Meta 分析中如何利用中位數、極差和樣本量估算均數、標準差. 中國循證醫學雜志, 2015, 15(4): 484-487.
5. 胡捷, 樊嘉, 徐泱, 等. 加速康復外科技術對肝腫瘤患者術后恢復的影響. 中華消化外科雜志, 2009, 8(4): 281-283.
6. 彭浪, 鄒書兵, 高崇茂, 等. 加速康復外科理念在原發性肝癌肝切除術圍手術期管理的應用價值. 中國普通外科雜志, 2017, 26(2): 218-222.
7. 禹亞彬, 祁付珍, 陳亞, 等. 加速康復在老年肝切除圍手術期的應用. 中華普通外科雜志, 2018, 33(8): 687-688.
8. 丁蔚, 張峰, 李國強, 等. 快速康復理念在肝癌肝切除術圍手術期處理中的應用. 中國普通外科雜志, 2013, 22(1): 32-36.
9. 何國林, 洪合, 程遠, 等. 快速康復外科理念在腹腔鏡肝切除術中的應用. 中華普通外科雜志, 2018, 33(8): 635-637.
10. 首志雄, 鄭達武, 羅永香, 等. 快速康復外科理念在肝癌肝切除術圍手術期管理中的臨床價值. 中華消化外科雜志, 2014, 13(6): 456-460.
11. 樊獻軍, 譚黃業, 肖詠梅, 等. 快速康復外科理念在肝癌圍手術期處理中的應用. 中國普通外科雜志, 2011, 20(7): 683-686.
12. 戴丐國. 外科快速康復理念在老年人肝癌肝切除圍術期處理中的應用. 中華老年醫學雜志, 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. 嚴錦, 王瑞蘭, 王繼濤, 等. 基于快速康復外科理念的肝癌患者圍術期護理流程應用. 護理學雜志, 2014, 29(16): 32-34.
20. 林德新, 李旋, 張勇, 等. 加速康復外科程序在肝膽管結石肝切除術中的應用. 中國普通外科雜志, 2018, 27(2): 169-174.
21. 余海波, 彭亞南, 董亞東, 等. 加速康復外科在腹腔鏡精準肝切除中的應用價值. 中華普通外科雜志, 2018, 33(5): 401-404.
22. 王謙, 柏斗勝, 蔣國慶, 等. 加速康復外科在原發性肝癌根治術中的應用研究. 中華普通外科雜志, 2018, 33(8): 638-641.
23. 任春霞, 李倫蘭, 丁萍, 等. 快速康復路徑在原發性肝癌患者圍手術期的應用. 中華疾病控制雜志, 2016, 20(6): 600-603, 608.
24. 徐春艷, 康璇, 楊麗紅, 等. 醫護一體化護理干預促進肝癌患者快速康復的效果. 解放軍護理雜志, 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, M?kisalo 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. 蘇艷, 任龍飛, 魏花萍, 等. 快速康復外科在開腹肝癌切除術中應用的 Meta 分析. 中國普通外科雜志, 2019, 28(2): 195-205.
34. 中華醫學會外科學分會, 中華醫學會麻醉學分會. 加速康復外科中國專家共識及路徑管理指南 (2018 版). 中國實用外科雜志, 2018, 38(1): 1-20.
35. 朱財林, 傅濤, 蔡遜. 快速康復外科對根治性遠端胃切除患者預后的影響. 現代腫瘤醫學, 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, 彭創, 趙暢, 等. 快速康復外科理念在肝癌肝切除圍手術期應用的 Meta 分析. 醫學臨床研究, 2016, 33(4): 625-629.
38. 任秋平, 楊健, 羅艷麗. 改良快速康復流程在開腹肝臟部分切除術圍手術期的應用. 華西醫學, 2017, 32(5): 717-722.
39. 曹勤, 丁佑銘, 汪斌, 等. 加速康復外科理念在腹腔鏡肝切除術治療肝膽管結石病中的應用. 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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