Oncologic and long-term outcomes of enhanced recovery after surgery in cancer surgeries — a systematic review

Background Clinical evidence has proved that enhanced recovery after surgery (ERAS) can improve short-term clinical outcomes after various types of surgeries, but the long-term benefits have not yet been examined, especially with respect to cancer surgeries. Therefore, a systematic review of the cur...

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Bibliographic Details
Published in:World journal of surgical oncology 2021-06, Vol.19 (1), p.1-191, Article 191
Main Authors: Pang, Qianyun, Duan, Liping, Jiang, Yan, Liu, Hongliang
Format: Article
Language:English
Subjects:
Bone surgery
Cancer
Cancer surgery
Cancer therapies
Care and treatment
Chemotherapy
Enhanced recovery after surgery
Laparoscopy
Long-term outcome
Medical prognosis
Metastases
Metastasis
Oncologic outcome
Patient outcomes
Patients
Perioperative care
Quality of life
Recovery
Recovery (Medical)
Review
Reviews
Surgery
Survival
Systematic review
Thoracic surgery
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Summary:Background Clinical evidence has proved that enhanced recovery after surgery (ERAS) can improve short-term clinical outcomes after various types of surgeries, but the long-term benefits have not yet been examined, especially with respect to cancer surgeries. Therefore, a systematic review of the current evidence was conducted. Methods The Pubmed, Cochrane Library, Embase, and Web of Science databases were searched using the following key words as search terms: "ERAS" or "enhanced recovery" or "fast track", "oncologic outcome", "recurrence", "metastasis", "long-term outcomes", "survival", and "cancer surgery". The articles were screened using the inclusion and exclusion criteria, and the data from the included studies were extracted and analyzed. Results A total of twenty-six articles were included in this review. Eighteen articles compared ERAS and conventional care, of which, 12 studies reported long-term overall survival (OS), and only 4 found the improvement by ERAS. Four studies reported disease-free survival (DFS), and only 1 found the improvement by ERAS. Five studies reported the outcomes of return to intended oncologic treatment after surgery (RIOT), and 4 found improvements in the ERAS group. Seven studies compared high adherence to ERAS with low adherence, of which, 6 reported the long-term OS, and 3 showed improvements by high adherence. One study reported high adherence could reduce the interval from surgery to RIOT. Four studies reported the effect of altering one single item within the ERAS protocol, but the results of 2 studies were controversial regarding the long-term OS between laparoscopic and open surgery, and 1 study showed improvements in OS with restrictive fluid therapy. Conclusions The use of ERAS in cancer surgeries can improve the on-time initiation and completion of adjuvant chemotherapy after surgery, and the high adherence to ERAS can lead to better outcomes than low adherence. Based on the current evidence, it is difficult to determine whether the ERAS protocol is associated with long-term overall survival or cancer-specific survival. Keywords: Enhanced recovery after surgery, Cancer surgery, Long-term outcome, Oncologic outcome
ISSN:1477-7819
1477-7819
DOI:10.1186/s12957-021-02306-2