Fast-track surgery in gastrectomy for gastric cancer: a systematic review and meta-analysis.

Purpose: Fast-track surgery aims to attenuate the surgical stress response, reduce complications, and shorten hospital stay. The goal of the present meta-analysis is to assess the safety and effectiveness of fast-track surgery in patients undergoing gastrectomy for gastric cancer compared with conventional perioperative care. Methods: PubMed, Embase, the Cochrane Central Register of Controlled Trials, and reference lists of the identified studies were searched to identify randomized clinical trials that compared fast-track surgery with conventional perioperative care in patients undergoing gastrectomy for gastric cancer. Results: Five studies with a total of 400 patients were included in the meta-analysis. Meta-analysis shows that postoperative hospital stay (weighted mean difference (WMD) −1.87 days, 95 % confidence interval (CI), −2.46 to −1.28 days, P < 0.00001), time to first passage of flatus (WMD −0.71 days, 95 % CI, −1.03 to −0.39 days, P < 0.0001), and hospital costs (WMD −505.87 dollars, 95 % CI, −649.91 to −361.84 dollars, P < 0.00001) were significantly reduced for fast-track surgery. No significant differences were found for readmission rates (relative risk (RR), 1.97 95 % CI, 0.37 to 10.64, P = 0.43) and total postoperative complications (RR, 0.99 95 % CI, 0.56 to 1.76, P = 0.97). Conclusions: Fast-track surgery is safe and effective in gastrectomy for gastric cancer. Further randomized trials are needed to strengthen the conclusions. [ABSTRACT FROM AUTHOR]