The Role of Enhanced Recovery after Surgery in Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis.

IF 16.4 1区 化学 Q1 CHEMISTRY, MULTIDISCIPLINARY
Accounts of Chemical Research Pub Date : 2024-01-01 Epub Date: 2024-07-16 DOI:10.1159/000539785
Despoina Liotiri, Alexandros Diamantis, Ismini Paraskeva, Alexandros Brotis, Dimitrios Symeonidis, Eleni Arnaoutoglou, Dimitrios Zacharoulis
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引用次数: 0

Abstract

Introduction: This study aimed to compare the safety and short-term outcomes of Enhanced Recovery After Surgery (ERAS) with standard care for patients undergoing pancreatoduodenectomy (PD) based on literature published following the first publication of ERAS guidelines for PD.

Methods: Five medical databases were searched for studies that compared ERAS to standard care in adults undergoing PD. Data on postoperative complications, length of hospitalization, readmissions, and time to chemotherapy were analyzed using either a fixed- or random-effects model meta-analysis. Meta-regressions were conducted to investigate the role of operative technique, study origin, and study design.

Results: Our analysis included 22 studies involving 4,043 patients. ERAS was associated with fewer complications (relative risk [RR]: 0.83; 0.75-0.91), particularly Clavien-Dindo (CD) grade 1 and 2 complications (RR: 0.82; 0.72-0.92), delayed gastric emptying (RR: 0.69; 0.52-0.93), and postoperative fistula (POPF) (RR: 0.76; 0.66-0.89), and a shorter time to chemotherapy (standardized mean difference [SMD]: -0.68; 95% CI: -0.88 to -0.48). ERAS did not affect the risk for CD grade 3 and 4 complications (RR: 1.00; 0.72-1.38), post-pancreatectomy hemorrhage (RR: 0.88; 0.67-1.14), length of stay (SMD: -0.56; 95% CI: -1.12 to 0.01), readmission (RR: 1.01; 0.84-1.21), and mortality (RR: 0.81; 0.54-1.22). The continent of origin was an effect moderator in the role of ERAS in CD grade 1 and 2 complications (p = 0.047) and POPF (p = 0.02).

Conclusion: Implementing ERAS principles in PD improves surgical outcomes without compromising safety. ERAS may also accelerate time to chemotherapy, an essential issue for future research.

ERAS在胰十二指肠切除术中的作用:系统回顾和荟萃分析。
引言 本研究旨在根据ERAS指南首次发布后发表的文献,比较ERAS与标准护理对胰十二指肠切除术(PD)患者的安全性和短期疗效。方法 在五个医学数据库中搜索了对接受胰十二指肠切除术的成人进行ERAS与标准护理比较的研究。采用固定效应或随机效应模型进行荟萃分析,对术后并发症、住院时间、再入院率和化疗时间等数据进行分析。通过元回归研究了手术技术、研究来源和研究设计的作用。结果 我们的分析包括 22 项研究,涉及 4043 名患者。ERAS 与较少的并发症相关(RR:0.83;0.75 至 0.91),尤其是 Clavien-Dindo (CD) 1 级和 2 级并发症(RR:0.82;0.72 至 0.92)、胃排空延迟(RR:0.69;0.52 至 0.93)和术后瘘(POPF)(RR:0.76;0.66 至 0.89),以及化疗时间缩短(SMD:-0.68;95% CI:-0.88 至 -0.48)。ERAS不会影响CD 3级和4级并发症(RR:1.00;0.72至1.38)、胰腺切除术后出血(RR:0.88;0.67至1.14)、住院时间(SMD:-0.56;95% CI:-1.12至0.01)、再次入院(RR:1.01;0.84至1.21)和死亡率(RR:0.81;0.54至1.22)的风险。对于ERAS在CD 1级和2级并发症(p= 0.047)和POPF(p=0.02)中的作用,原籍国是一个效应调节因子。结论 在腹腔镜手术中实施ERAS原则可在不影响安全性的前提下改善手术效果。ERAS还可能加快化疗时间,这是未来研究的一个重要问题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Accounts of Chemical Research
Accounts of Chemical Research 化学-化学综合
CiteScore
31.40
自引率
1.10%
发文量
312
审稿时长
2 months
期刊介绍: Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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