ReviewEnhanced recovery after surgery programs versus traditional perioperative care in laparoscopic hepatectomy: A meta-analysis

- We summarized that the application of ERAS in laparoscopic hepatectomy is safe and effective, and it could accelerate the postoperative recovery and lighten the financial burden of patients.
- According to our study, ERAS could accelerate the time to first diet and first flatus, and decrease duration of the postoperative hospital stay, the cost of hospitalization, postoperative complication rate after surgery.
- ERAS have the potential to replace CTL as the gold standard perioperative care for patients undergoing laparoscopic hepatectomy.

ObjectiveEnhanced recovery after surgery (ERAS) programs are a series of measures being taken during the perioperation to alleviate surgical stress and accelerate the recovery rate of patients. Although several studies reported the efficacy of ERAS in liver surgery, the role of ERAS in laparoscopic hepatectomy is still unclear. This meta-analysis is aimed to evaluate the efficacy and safety of ERAS programs versus traditional care in laparoscopic hepatectomy.MethodsWe searched PubMed, EMBASE, the Cochrane Library, CNKI, Wang Fang Database and VIP Database for randomized controlled trials (RCTs) or clinical controlled trials (CCTs) concerning using ERAS in laparoscopic hepatectomy. Data collection ended in June 1st, 2016. The main end points were intraoperative blood loss, intraoperative blood transfusion, operative time, the cost of hospitalization, time to first flatus, the time to first diet after surgery, duration of postoperative hospital stay, total postoperative complication rate, gradeⅠcomplication rate, grade Ⅱ-Ⅴcomplication rate.Results8 studies with 580 patients were eligible for analysis. There were 292 cases in ERAS group and 288 cases in traditional perioperative care (CTL) group. Compared with CTL group, ERAS group was associated with significantly accelerated of time to first diet after surgery (SMD = −1.79, 95%CI: −3.19 ∼ −0.38, P = 0.01), time to first flatus (MD = −0.51, 95%CI: −0.91 ∼ −0.12, P = 0.01). Meanwhile, it was associated with significantly decreased of duration of the postoperative hospital stay (MD = −3.31, 95%CI: −3.95 ∼ −2.67, P < 0.00001), cost of hospitalization (MD = −1.0, 95%CI: −1.49 ∼ −0.51, P < 0.0001), total postoperative complication rate (OR = 0.34, 95%CI: 0.15-0.75, P = 0.008), gradeⅠcomplication rate (OR = 0.37, 95%CI: 0.22-0.64, P = 0.0003) and gradeⅡ-Ⅴcomplication rate (OR = 0.49, 95%CI: 0.32-0.77, P = 0.002). Whereas there was no significantly difference in intraoperative blood loss (P > 0.05), intraoperative blood transfusion (P > 0.05), operative time (P > 0.05) between ERAS group and CTL group.ConclusionApplication of ERAS in laparoscopic hepatectomy is safe and effective, and it could accelerate the postoperative recovery and lighten the financial burden of patients.