Efficacy and safety of fast track surgery in adrenalectomy: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Haiyan ,  WANG Li , ZHU Bili , LI Yumei

Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, P.R.China;

Corresponding?author：

WANG Li, Email: 379157401@qq.com

Keywords：

Adrenalectomy; Fast track surgery; Perioperative period; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.201904010

Video：

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Objectives To systematically review the efficacy and safety of fast track surgery in perioperative patients with adrenalectomy.Methods PubMed, EMbase, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of fast track surgery in perioperative patients with adrenalectomy from inception to January 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 11 RCTs involving 1 034 patients were included. The results of meta-analysis showed that: fast track surgery in perioperative patients with adrenalectomy could shorten first exhaust time (MD=?17.16, 95%CI ?21.86 to ?12.46, P<0.000 01), postoperative catheter indwelling time (MD=?43.44, 95%CI ?46.65 to ?40.23, P<0.000 01) and drainage tube indwelling time (MD=?39.91, 95%CI ?57.58 to ?22.23, P<0.000 01), and reduce the incidence of complications after adrenalectomy (OR=0.26, 95%CI 0.1 to 0.39, P<0.000 01). There were no statistically differences in operation time (MD=?1.18, 95%CI ?3.22 to 0.86, P=0.26) and blood loss (MD=0.25, 95%CI ?2.84 to 3.34, P=0.88) between two groups.Conclusions Current evidence shows that, compared with the conventional rehabilitation group, fast track surgery can promote postoperative recovery of patients with adrenalectomy more safely and effectively, which has clinical promotion value. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.

Citation： WANG Haiyan, WANG Li, ZHU Bili, LI Yumei. Efficacy and safety of fast track surgery in adrenalectomy: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(10): 1211-1216. doi: 10.7507/1672-2531.201904010 Copy

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2.	Gemmill EH, Humes DJ, Catton JA. Systematic review of enhanced recovery after gastro-oesophageal cancer surgery. Ann R Coll Surg Engl, 2015, 97(3): 173-179.
3.	Tang CP, Xu ZY, Yi XM, et al. Fast track surgery vs. conventional management in the perioperative care of retroperitoneal laparoscopic adrenalectomy. Int J Clin Exp Med, 2015, 8(9): 16207-16214.
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11.	許露偉, 周六化. 快速康復外科技術在經腹腹腔鏡腎上腺腫瘤切除術圍手術期的臨床應用. 山西醫藥雜志, 2017, 46(20): 2459-2461.
12.	閻淑芹, 李靜. 加速康復外科運用于后腹腔鏡腎上腺切除術的安全性及有效性研究. 護理實踐與研究, 2015, 12(10): 47-48.
13.	陳惠洪, 陳琴珠, 林爭艷. 快速康復外科護理在后腹腔鏡下腎上腺手術病人圍術期中的應用. 全科護理, 2017, 15(21): 2561-2564.
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15.	Stergiopoulou A, Birbas K, Katostaras T, et al. The effect of interactive multimedia on preoperative knowledge and postoperative recovery of patients undergoing laparoscopic cholecystectomy. Methods Inf Med, 2007, 46(4): 406-409.
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17.	Andersen HK, Lewis SJ, Thomas S. Early enteral nutrition within 24 h of eolorectal surgry versus later commencement of feeding for postoperative complications. Cochrane Database Syst Rev, 2006, (4): CD004080.
18.	張靜, 孫梅林, 李飛. 綜合性保溫措施在快速康復外科后腹腔鏡下腎上腺切除術中的應用. 中國醫學創新, 2017, 14(3): 89-92.
19.	郭振, 李幼生. 圍手術期液體治療在結直腸快通道外科中的應用. 醫學研究生學報, 2011, 24(9): 993-996.
20.	Hübner M, Sch?fer M, Demartines N, et al. Impact of restrictive intravenous fluid replacement and combined epidural analgesia on perioperative volume balance and renal function within a Fast Track program. J Surg Res, 2012, 173(1): 68-74.
21.	Zhao JH, Sun JX, Huang XZ, et al. Meta-analysis of the laparoscopic versus open colorectal surgery within fast track surgery. Int J Colorectal Dis, 2016, 31(3): 613-622.
22.	劉晶晶, 魯嘉駒, 師將, 等. 快速康復外科在食管癌手術患者中應用效果的系統評價與 Meta 分析. 中國胸心血管外科臨床雜志, 2018, 25(7): 596-603.
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24.	Nygren J, Thacker J, Carli F, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Clin Nutr, 2012, 31(6): 801-816.
25.	Lassen K, Coolsen MM, Slim K, et al. Guidelines for perioperative care for pancreaticoduoden-ectomy: Enhanced Recovery After Surgery (ERAS) Society recommendations. Clin Nutr, 2012, 31(6): 817-830.
26.	Maffezzini M, Campodonico F, Capponi G, et al. Fast-track surgery and technical nuances to reduce complications after radical cystectomy and intestinal urinary diversion with the modified Indiana pouch. Surg Oncol, 2012, 21(3): 191-195.

1. Wainwright TW, Immins T, Middleton RG. Enhanced recovery after surgery (ERAS) and its applicability for major spine surgery. Best Pract Res Clin Anaesthesiol, 2016, 30(1): 91-102.
2. Gemmill EH, Humes DJ, Catton JA. Systematic review of enhanced recovery after gastro-oesophageal cancer surgery. Ann R Coll Surg Engl, 2015, 97(3): 173-179.
3. Tang CP, Xu ZY, Yi XM, et al. Fast track surgery vs. conventional management in the perioperative care of retroperitoneal laparoscopic adrenalectomy. Int J Clin Exp Med, 2015, 8(9): 16207-16214.
4. 唐朝朋, 徐振宇, 高建平, 等. 加速康復外科在后腹腔鏡腎上腺切除術中的應用. 醫學研究生學報, 2014, 27(8): 829-832.
5. 孫梅林, 丁萍, 張靜, 等. 快速康復外科護理在后腹腔鏡下腎上腺切除術中的應用觀察. 護理研究, 2016, 30(13): 1622-1625.
6. 尹文文, 丁華, 侯翠翠, 等. 快速康復外科理念在后腹腔鏡下腎上腺腫瘤切除術圍術期中的應用. 微創泌尿外科雜志, 2016, 5(1): 52-55.
7. 董雅琪, 楊利英. 快速康復外科理念在后腹腔鏡下腎上腺腫瘤切除術圍術期護理中的應用. 全科護理, 2018, 16(4): 402-404.
8. 李劍梅. 快速康復外科護理在后腹腔鏡下腎上腺切除術中的應用分析. 臨床醫藥文獻電子雜志, 2017, 4(96): 18906-18907.
9. 梁偉霞, 蘇蕾, 韋穎, 等. 快速康復護理在腹腔鏡治療腎上腺疾病中的應用. 微創醫學, 2014, 9(6): 800-801.
10. 張其強, 趙海衛, 張學寶, 等. 加速康復外科在后腹腔鏡腎上腺切除術中的應用. 國際泌尿系統雜志, 2018, 38(5): 785-788.
11. 許露偉, 周六化. 快速康復外科技術在經腹腹腔鏡腎上腺腫瘤切除術圍手術期的臨床應用. 山西醫藥雜志, 2017, 46(20): 2459-2461.
12. 閻淑芹, 李靜. 加速康復外科運用于后腹腔鏡腎上腺切除術的安全性及有效性研究. 護理實踐與研究, 2015, 12(10): 47-48.
13. 陳惠洪, 陳琴珠, 林爭艷. 快速康復外科護理在后腹腔鏡下腎上腺手術病人圍術期中的應用. 全科護理, 2017, 15(21): 2561-2564.
14. 趙俊智. 圍手術期患者的心理護理. 中國醫藥指南, 2012, 10(16): 345-346.
15. Stergiopoulou A, Birbas K, Katostaras T, et al. The effect of interactive multimedia on preoperative knowledge and postoperative recovery of patients undergoing laparoscopic cholecystectomy. Methods Inf Med, 2007, 46(4): 406-409.
16. Slim K, Vicaut E, Launay-Savary MV, et al. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg, 2009, 249(2): 203-209.
17. Andersen HK, Lewis SJ, Thomas S. Early enteral nutrition within 24 h of eolorectal surgry versus later commencement of feeding for postoperative complications. Cochrane Database Syst Rev, 2006, (4): CD004080.
18. 張靜, 孫梅林, 李飛. 綜合性保溫措施在快速康復外科后腹腔鏡下腎上腺切除術中的應用. 中國醫學創新, 2017, 14(3): 89-92.
19. 郭振, 李幼生. 圍手術期液體治療在結直腸快通道外科中的應用. 醫學研究生學報, 2011, 24(9): 993-996.
20. Hübner M, Sch?fer M, Demartines N, et al. Impact of restrictive intravenous fluid replacement and combined epidural analgesia on perioperative volume balance and renal function within a Fast Track program. J Surg Res, 2012, 173(1): 68-74.
21. Zhao JH, Sun JX, Huang XZ, et al. Meta-analysis of the laparoscopic versus open colorectal surgery within fast track surgery. Int J Colorectal Dis, 2016, 31(3): 613-622.
22. 劉晶晶, 魯嘉駒, 師將, 等. 快速康復外科在食管癌手術患者中應用效果的系統評價與 Meta 分析. 中國胸心血管外科臨床雜志, 2018, 25(7): 596-603.
23. 結直腸手術應用加速康復外科中國專家共識(2015 版). 中華胃腸外科雜志, 2015, 18(8): 785-787.
24. Nygren J, Thacker J, Carli F, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Clin Nutr, 2012, 31(6): 801-816.
25. Lassen K, Coolsen MM, Slim K, et al. Guidelines for perioperative care for pancreaticoduoden-ectomy: Enhanced Recovery After Surgery (ERAS) Society recommendations. Clin Nutr, 2012, 31(6): 817-830.
26. Maffezzini M, Campodonico F, Capponi G, et al. Fast-track surgery and technical nuances to reduce complications after radical cystectomy and intestinal urinary diversion with the modified Indiana pouch. Surg Oncol, 2012, 21(3): 191-195.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of fast track surgery in adrenalectomy: a meta-analysis

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