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A systematic review and meta-analysis of the safety profile of fast-track surgery for colorectal surgery

  • Review Article
  • Published:
Central European Journal of Medicine

Abstract

Background

The aim of this study was to evaluate the safety profile of fast-track surgery (FTS) compared to standard care in elective colorectal surgery involving segmental colonic and/or rectal resection.

Methods

All of the randomized controlled trials (RCTs) and non-randomized controlled clinical trials (CCTs) on FTS for colorectal surgery were analyzed with the Cochrane systematic review. Database retrievals of Medline, Embase and Cochrane was were conducted, together with two published FTS meta-analyses. Two reviewers independently assessed the quality of the studies, extracted the relevant data and performed a cross-check. A metaanalysis was performed with RevMan 5 software.

Results

A total of 15 studies were reviewed in this study, including 13 articles in English and 2 articles in Chinese, of which 7 were RCTs and 8 were CCTs. The overall rates of morbidity and readmission in the FTS group were lower compared to patients who underwent the conventional treatments (conventional treatment group or control group) in the RCTs but tended to increase in the CCTs. There were no statistically significant differences between the FTS group and the control group regarding ileus, anastomotic leakage, abdominal distention, nausea and vomiting, urinary retention and infection of the incisional wound.

Conclusion

The overall rates of morbidity and readmission in the FTS group were similar or even lower compared to the control group in RCTs, with an increasing trend in the CCTs. Further discussion is needed as to why the results of the RCTs were not repeated in the CCTs, especially with regard to the causes of readmission. It should also be determined whether an early discharge might cause a delay in the diagnosis of some complications, and thereby the occurrence of serious complications. If a number of severe complications occurred due to an early discharge, the value of FTS would be in question.

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Authors and Affiliations

  1. National Center of Colorectal Surgery, The Third Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, 1 Jinling Road, Nanjing, 210001, China

    Jin Heiying & Qiang Leng

  2. Department of surgery, Jiangyin Hospital of Traditional Chinese Medicine, 130 Remin Zhonglu, Jiangyin, 214400, Jiangsu, China

    Wei Gong

Authors
  1. Jin Heiying
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  2. Qiang Leng
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  3. Wei Gong
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Correspondence to Jin Heiying.

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Heiying, J., Leng, Q. & Gong, W. A systematic review and meta-analysis of the safety profile of fast-track surgery for colorectal surgery. cent.eur.j.med 8, 398–405 (2013). https://doi.org/10.2478/s11536-012-0129-2

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  • DOI: https://doi.org/10.2478/s11536-012-0129-2

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