title: Fast-track program vs traditional care in surgery for gastric cancer.
abstract: OBJECTIVE
  To systematically review the evidence for the effectiveness of fast-track program vs traditional care in laparoscopic or open surgery for gastric cancer.
  
  
  METHODS
  PubMed, Embase and the Cochrane library databases were electronically searched for published studies between January 1995 and April 2013, and only randomized trials were included. The references of relevant studies were manually searched for further studies that may have been missed. Search terms included "gastric cancer", "fast track" and "enhanced recovery". Five outcome variables were considered most suitable for analysis: postoperative hospital stay, medical cost, duration to first flatus, C-reactive protein (CRP) level and complications. Postoperative hospital stay was calculated from the date of operation to the date of discharge. Fixed effects model was used for meta-analysis.
  
  
  RESULTS
  Compared with traditional care, fast-track program could significantly decrease the postoperative hospital stay [weighted mean difference (WMD) = -1.19, 95%CI: -1.79--0.60, P = 0.0001, fixed model], duration to first flatus (WMD = -6.82, 95%CI: -11.51--2.13, P = 0.004), medical costs (WMD = -2590, 95%CI: -4054--1126, P = 0.001), and the level of CRP (WMD = -17.78, 95%CI: -32.22--3.35, P = 0.0001) in laparoscopic surgery for gastric cancer. In open surgery for gastric cancer, fast-track program could also significantly decrease the postoperative hospital stay (WMD = -1.99, 95%CI: -2.09--1.89, P = 0.0001), duration to first flatus (WMD = -12.0, 95%CI: -18.89--5.11, P = 0.001), medical cost (WMD = -3674, 95%CI: -5025--2323, P = 0.0001), and the level of CRP (WMD = -27.34, 95%CI: -35.42--19.26, P = 0.0001). Furthermore, fast-track program did not significantly increase the incidence of complication (RR = 1.39, 95%CI: 0.77-2.51, P = 0.27, for laparoscopic surgery; and RR = 1.52, 95%CI: 0.90-2.56, P = 0.12, for open surgery).
  
  
  CONCLUSIONS
  Our overall results suggested that compared with traditional care, fast-track program could result in shorter postoperative hospital stay, less medical costs, and lower level of CRP, with no more complications occurring in both laparoscopic and open surgery for gastric cancer.
authors.affiliation: Zhi-Xing Chen, Ae-Huey Jennifer Liu, Ying Cen, Department of Burns and Plastic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Zhi-Xing
authors.initials: ZX
authors.lastname: Chen
authors.affiliation: Zhi-Xing Chen, Ae-Huey Jennifer Liu, Ying Cen, Department of Burns and Plastic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Ae-Huey Jennifer
authors.initials: AH
authors.lastname: Liu
authors.affiliation: Zhi-Xing Chen, Ae-Huey Jennifer Liu, Ying Cen, Department of Burns and Plastic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Cen
mesh_terms: D017046:Cost Savings; D003362:Cost-Benefit Analysis; D019091:Critical Pathways; D005743:Gastrectomy / Q000191:economics / Q000379:methods*; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D007902:Length of Stay / Q000191:economics; D011182:Postoperative Care / Q000191:economics / Q000379:methods*; D015397:Program Evaluation; D020127:Recovery of Function; D013274:Stomach Neoplasms / Q000191:economics / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Fast-track program; Gastric cancer; Laparoscopic and open surgery; Meta-analysis; Traditional care