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Open Access Research article

Fast-track surgery versus traditional perioperative care in laparoscopic colorectal cancer surgery: a meta-analysis

Jun-hua Zhao, Jing-xu Sun, Peng Gao, Xiao-wan Chen, Yong-xi Song, Xuan-zhang Huang, Hui-mian Xu and Zhen-ning Wang*

Author Affiliations

Department of Surgical Oncology and General Surgery, the First Hospital of China Medical University, Shenyang 110001, People’s Republic of China

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BMC Cancer 2014, 14:607  doi:10.1186/1471-2407-14-607

Published: 23 August 2014

Abstract

Background

Both laparoscopic and fast-track surgery (FTS) have shown some advantages in colorectal surgery. However, the effectiveness of using both methods together is unclear. We performed this meta-analysis to compare the effects of FTS with those of traditional perioperative care in laparoscopic colorectal cancer surgery.

Methods

We searched the PubMed, EMBASE, Cochrane Library, and Ovid databases for eligible studies until April 2014. The main end points were the duration of the postoperative hospital stay, time to first flatus after surgery, time of first bowel movement, total postoperative complication rate, readmission rate, and mortality.

Results

Five randomized controlled trials and 5 clinical controlled trials with 1,317 patients were eligible for analysis. The duration of the postoperative hospital stay (weighted mean difference [WMD], –1.64 days; 95% confidence interval [CI], –2.25 to –1.03; p < 0.001), time to first flatus (WMD, –0.40 day; 95% CI, –0.77 to –0.04; p = 0.03), time of first bowel movement (WMD, –0.98 day; 95% CI, –1.45 to –0.52; p < 0.001), and total postoperative complication rate (risk ratio [RR], 0.67; 95% CI, 0.56–0.80; p < 0.001) were significantly reduced in the FTS group. No significant differences were noted in the readmission rate (RR, 0.64; 95% CI, 0.41–1.01; p = 0.06) or mortality (RR, 1.55; 95% CI, 0.42–5.71; p = 0.51).

Conclusion

Among patients undergoing laparoscopic colorectal cancer surgery, FTS is associated with a significantly shorter postoperative hospital stay, more rapid postoperative recovery, and, notably, greater safety than is expected from traditional care.

Keywords:
Fast track surgery; Laparoscopic surgery; Colorectal cancer