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Review
. 2022 Jun 30;9(11):100110.
doi: 10.1016/j.apjon.2022.100110. eCollection 2022 Nov.

Outcomes of enhanced recovery after surgery in lung cancer: A systematic review and meta-analysis

Wenhui Zhang  1   2 , Yuting Zhang  1   2 , Yi Qin  3 , Jiahai Shi  2
Affiliations
Review

Outcomes of enhanced recovery after surgery in lung cancer: A systematic review and meta-analysis

Wenhui Zhang et al. Asia Pac J Oncol Nurs. .

Abstract

Objective: To assess the effect of ERAS on clinical prognosis in perioperative patients following lung cancer surgery.

Methods: PubMed, Web of Science, MEDLINE, EMBASE, and other databases were systematically searched from inception to December 2021. Randomized controlled trials and peer-reviewed cohort studies on the use of ERAS in lung cancer surgery patients were included. Primary outcomes comprised visual analog scale scores after treatment and quality of life. Secondary outcomes comprised complication rate, function-related outcomes (chest tube indwelling time and first ambulation), and length of stay. Statistical analysis was performed using RevMan 5.4.1 software.

Results: Finally, 23 studies were included (12 cohort studies and 11 randomized controlled trials) with a total of 8094 patients. Meta-analysis showed that ERAS significantly reduced visual analog scale scores (mean difference [MD] = -1.99, 95% confidence interval [CI] = -2.45, -1.54, P < 0.01), reduced the incidence of complications (odds ratio = 0.48, 95% CI = 0.37, 0.61, P < 0.01), shortened chest tube indwelling time (MD = -2.20, 95% CI = -2.75, -1.64, P < 0.01), accelerated first ambulation (MD = -1.48, 95% CI = -1.77, -1.19, P < 0.01), shortened length of stay (MD = -2.70, 95% CI = -3.05, -2.36, P < 0.01), and improved quality of life (MD = 10.3, 95% CI = 9.59, 11.02, P < 0.01).

Conclusions: ERAS can accelerate postoperative recovery and improve quality of life. These findings support the use of ERAS as a standard of care for lung cancer surgery patients. However, the evidence quality was moderate and there were significant differences among studies. More high-quality studies incorporating relevant outcomes are needed for confirmation.

Keywords: Enhanced recovery after surgery; Meta-analysis; lung cancer; perioperative care; systematic review.

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Figures

Fig. 1
Fig. 1
Study selection flowchart. Transparent reporting outline of the search strategy results from initial search to included studies.
Fig. 2
Fig. 2
The risk of bias of randomized controlled trials. Green represents low risk; yellow represents unclear risk; red represents high risk. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
Fig. 3
Fig. 3
Forest plot of VAS scores after treatment. Meta-analysis comparing ERAS versus standard recovery for postoperative pain after lung cancer surgery. ERAS, enhanced recovery after surgery; VAS, visual analog scale.
Fig. 4
Fig. 4
Forest plot of quality of life. Meta-analysis comparing ERAS versus standard recovery for quality of life after lung cancer surgery. ERAS, enhanced recovery after surgery.
Fig. 5
Fig. 5
Forest plot of the complication rate. Meta-analysis comparing ERAS versus standard recovery for the complication rate after lung cancer surgery. ERAS, enhanced recovery after surgery.
Fig. 6
Fig. 6
Forest plot of chest tube indwelling time. Meta-analysis comparing ERAS versus standard recovery for chest tube indwelling time after lung cancer surgery. ERAS, enhanced recovery after surgery.
Fig. 7
Fig. 7
Forest plot of first ambulation. Meta-analysis comparing ERAS versus standard recovery for first ambulation after lung cancer surgery. ERAS: enhanced recovery after surgery.
Fig. 8
Fig. 8
Forest plot of length of stay. Meta-analysis comparing ERAS versus standard recovery for length of stay after lung cancer surgery. ERAS, enhanced recovery after surgery.
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