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Impact of enhanced recovery program on patients with esophageal cancer in comparison with traditional care

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Abstract

Purpose

Enhanced recovery program (ERP) was reported to be beneficial to patients undergoing esophageal surgery. However, evidence for ERP as a new standard perioperative pathway is insufficient. This meta-analysis aims to systematically investigate the differences between ERP and traditional care in terms of postoperative outcomes.

Methods

Studies comparing ERP with traditional care were searched in Pubmed and Ovid databases and subsequently analyzed. The primary outcome of interest was postoperative length of hospital stay (LOHS), and the secondary outcomes of interest were postoperative morbidity, mortality, and 30-day readmission rates. Statistical analysis was performed using weighted mean difference (WMD) and odds ratio (OR). Review Manager 5.3 was used to generate the eligible data.

Results

Thirteen studies with 2358 patients (1182 patients in the ERP group and 1176 patients in the control group) were included in this meta-analysis. The total LOHS (WMD −5.37; 95 % confidence interval (CI) −7.74 to −2.99; p < 0.00001) was significantly shorter in the ERP group than the control group. No statistically significant difference was found in morbidity (OR 0.78; 95 % confidence interval 0.58 to 1.05; p = 0.10), mortality (OR 0.76; 95 % CI 0.40 to 1.46; p = 0.41), and 30-day readmission rates (OR 1.01; 95 % CI 0.70 to 1.46; p = 0.97).

Conclusions

This meta-analysis suggested that the implementation of ERP led to a reduction in LOHS, while morbidity, mortality, and 30-day readmission rates did not increase compared with traditional care in patients undergoing surgery for esophageal cancer.

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Authors and Affiliations

  1. State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People’s Republic of China

    Lihong Wang, Chenjing Zhu, Xuelei Ma, Kai Shen, Hongmei Li, Jing Zhang & Ping Li

  2. West China School of Medicine, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People’s Republic of China

    Yuanyuan Hu & Linghong Guo

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  1. Lihong Wang
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  2. Chenjing Zhu
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  3. Xuelei Ma
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Correspondence to Xuelei Ma or Ping Li.

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Lihong Wang, Chenjing Zhu, and Xuelei Ma contributed equally to this work

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Wang, L., Zhu, C., Ma, X. et al. Impact of enhanced recovery program on patients with esophageal cancer in comparison with traditional care. Support Care Cancer 25, 381–389 (2017). https://doi.org/10.1007/s00520-016-3410-0

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