title: Fast-track surgery versus traditional perioperative care in laparoscopic colorectal cancer surgery: a meta-analysis.
abstract: BACKGROUND
  Both laparoscopic and fast-track surgery (FTS) have shown some advantages in colorectal surgery. However, the effectiveness of using both methods together is unclear. We performed this meta-analysis to compare the effects of FTS with those of traditional perioperative care in laparoscopic colorectal cancer surgery.
  
  
  METHODS
  We searched the PubMed, EMBASE, Cochrane Library, and Ovid databases for eligible studies until April 2014. The main end points were the duration of the postoperative hospital stay, time to first flatus after surgery, time of first bowel movement, total postoperative complication rate, readmission rate, and mortality.
  
  
  RESULTS
  Five randomized controlled trials and 5 clinical controlled trials with 1,317 patients were eligible for analysis. The duration of the postoperative hospital stay (weighted mean difference [WMD], -1.64 days; 95% confidence interval [CI], -2.25 to -1.03; p < 0.001), time to first flatus (WMD, -0.40 day; 95% CI, -0.77 to -0.04; p = 0.03), time of first bowel movement (WMD, -0.98 day; 95% CI, -1.45 to -0.52; p < 0.001), and total postoperative complication rate (risk ratio [RR], 0.67; 95% CI, 0.56-0.80; p < 0.001) were significantly reduced in the FTS group. No significant differences were noted in the readmission rate (RR, 0.64; 95% CI, 0.41-1.01; p = 0.06) or mortality (RR, 1.55; 95% CI, 0.42-5.71; p = 0.51).
  
  
  CONCLUSIONS
  Among patients undergoing laparoscopic colorectal cancer surgery, FTS is associated with a significantly shorter postoperative hospital stay, more rapid postoperative recovery, and, notably, greater safety than is expected from traditional care.
authors.forename: Jun-Hua
authors.initials: JH
authors.lastname: Zhao
authors.forename: Jing-Xu
authors.initials: JX
authors.lastname: Sun
authors.forename: Peng
authors.initials: P
authors.lastname: Gao
authors.forename: Xiao-Wan
authors.initials: XW
authors.lastname: Chen
authors.forename: Yong-Xi
authors.initials: YX
authors.lastname: Song
authors.forename: Xuan-Zhang
authors.initials: XZ
authors.lastname: Huang
authors.forename: Hui-Mian
authors.initials: HM
authors.lastname: Xu
authors.affiliation: Department of Surgical Oncology and General Surgery, the First Hospital of China Medical University, Shenyang 110001, People's Republic of China. josieon826@sina.cn.
authors.forename: Zhen-Ning
authors.initials: ZN
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002986:Clinical Trials as Topic; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D003107:Colorectal Surgery / Q000379:methods; D016206:Databases, Bibliographic; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D020127:Recovery of Function