Assessment of the efficacy and safety of enhanced recovery after surgery in the thoracoscopic adjuvant treatment of radical surgery for oesophageal carcinoma: A systematic review and meta-analysis

OBJECTIVE: To investigate the efficacy and safety assessment of intensive post-operative recovery during thoracoscopic-assisted radical oesophageal carcinoma (OC) treatment. PATIENTS AND METHODS: The meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and English terms were searched in PubMed, Embase, Cochrane Library (2020, Issue 1) and Web of Science, and the same Chinese terms were searched in China National Knowledge Internet and Wanfang Data, with the date range set from January 2010 to January 2020. Search engines, including Google Scholar and Baidu Library, were also applied for manual searches of relevant literature. The final number of articles included was 12, 11 of which were in Chinese and one in English. The basic data of the two groups were statistically analysed. Among 1049 OC patients, 527 were treated with enhanced recovery after surgery (ERAS) and 522 were treated with conventional perioperative management (control group), comparing the operative time, intraoperative blood loss, self-rating anxiety scale (SAS), visual analog scale (VAS), post-operative first venting time, chest tube removal time, post-operative hospitalisation time, post-operative hospitalisation cost, combined complication rate, lung infection rate, anastomotic leak rate and gastric emptying disorder rate. RESULTS: There were statistically significant differences between the ERAS group and the control group in terms of operative day anxiety score, post-operative Visual Analogue Scale, time to first post-operative anal vent, time to chest tube removal, post-operative hospital stay, hospitalisation cost and overall complication rate (weighted mean difference [WMD] = -5.61, 95% confidence interval [CI]: -7.95 to -3.28, P < 0.00001; WMD = -1.58, 95% CI: -1.58, -1.94 to -1.22, P < 0.00001; standardized mean difference [SMD] = -1.86, 95% CI: -2.53 to -1.18, P < 0.00001; SMD = -4.97, 95% CI: -6:73 to -3.21, P < 0.00001; WMD = -3.93, 95% CI: -4.80 to -3.07, P < 0.00001; WMD = -0.65, 95% CI: -0.74~-0.55, P < 0.00001 and relative risk [RR] =0.41, 95% CI: 0.33-0.51, P < 0.00001). ERAS reduced the incidence of pulmonary infection, anastomotic leak and impaired gastric emptying with a statistically significant difference (RR =0.45, 95% CI: 0.31-0.65, P < 0.0001; RR =0.34, 95% CI: 0.16-0.74, P < 0.05; RR =0.34, 95% CI: 0.16-0.73, P < 0.05). CONCLUSION: ERAS is effective in patients with OC undergoing thoracoscopic-assisted radical OC treatment to improve patients' clinical symptoms and reduce the incidence of adverse effects.