Enhanced Recovery after Surgery Programs for Liver Resection: a Meta-analysis
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Background and Aims
Due to the limited number of high-quality randomized controlled trials on enhanced recovery after surgery for hepatectomy, previous reviews have not been sufficiently comprehensive. Our objectives were to evaluate and compare the safety and efficacy of enhanced recovery after surgery programs and traditional care in patients undergoing open or laparoscopic surgery and to assess the optimized items for hepatectomy.
We searched the PubMed, Embase, and the Cochrane Library databases for all the relevant studies regardless of study design. We assessed the methodological quality of the included studies and excluded studies of poor quality. We performed a meta-analysis using RevMan 5.3 software.
In total, 19 original studies with 2575 patients, including four randomized controlled trials and 15 non-randomized controlled trials, were analyzed. The meta-analysis demonstrated that enhanced recovery after surgery programs could reduce morbidity, hospital stays and cost, blood loss, and time to bowel function recovery for both open and laparoscopic surgery without increasing mortality, readmission rate, or transfusion rate. Twelve items were essential for liver surgery.
Enhanced recovery after surgery programs for hepatectomy are feasible and efficient. Further studies should optimize perioperative outcomes for liver surgery.
KeywordsEnhanced recovery after surgery Liver resection Liver surgery Hepatectomy Meta-analysis
Our deepest gratitude goes to the authors of all the included studies and others who helped improve this paper substantially.
Cheng Wang and Zheping Fang designed the study; Cheng Wang and Guoqun Zheng performed the literature search; Cheng Wang and Wenlong Zhang collected the data; Cheng Wang and Fabiao Zhang assessed the literature quality; Cheng Wang, Zheping Fang, Shangdong Lv, and Aidong Wang analyzed the data; and Cheng Wang wrote the manuscript.
Compliance with Ethical Standards
Our study was supported by the Science Technology Program of Zhejiang Province through the Zhejiang Provincial Health Department Project (grant no. 2015KYB434, 2017KY161), Zhejiang natural fund project of China (LY17H160069), Taizhou science and technology plan project (1602KY21, 162yw03, 14SF03).
Conflicts of Interest
The authors declare that they have no conflict of interest.
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