Is the Enhanced Recovery After Surgery (ERAS) Program Effective and Safe in Laparoscopic Colorectal Cancer Surgery? A Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Enhanced recovery after surgery (ERAS) program has shown a few advantages in colorectal cancer surgery. However, the effectiveness of the ERAS program in laparoscopic colorectal cancer surgery is still unclear. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of ERAS program in laparoscopic colorectal cancer surgery compared with traditional perioperative care (TC).

Methods: PubMed, EMBASE, Web of Science, The Cochrane Library, and ClinicalTrials.gov were searched for eligible RCTs comparing ERAS program with TC in laparoscopic colorectal cancer surgery. The main outcomes included the average length of postoperative hospital stay (PHS), time to first flatus and defecation, overall complication, readmission, and mortality rates were undertaken.

Results: Thirteen RCTs involving 1298 patients were included in our study (639 in ERAS group and 659 in TC group). ERAS group had shorter average length of PHS (weighted mean difference [WMD] - 2.00 day, 95% confidence interval [CI] - 2.52 to - 1.48, p = 0.00), time to first flatus (WMD - 12.18 h, 95%CI - 16.69 to - 7.67, p = 0.00), and time to first defecation (WMD - 32.93 h, 95%CI - 45.36 to - 20.50, p = 0.00) than TC group. In addition, the overall complication rates (risk ratio [RR] 0.59, 95%CI 0.40 to 0.86, p < 0.01) were significantly lower in ERAS group compared with TC group.

Conclusions: The results indicated that ERAS program is a much better effective and safe protocol for laparoscopic colorectal cancer surgery compared with TC. Hence, ERAS program should be recommended in laparoscopic colorectal cancer surgery.

Keywords: Colorectal cancer; Enhanced recovery after surgery; Laparoscopic surgery; Meta-analysis.