title: Meta-analysis of efficacy and safety of fast-track surgery in gastrectomy for gastric cancer.
abstract: BACKGROUND
  Fast-track surgery (FTS) is a promising program for surgical patients and has been applied to several surgical diseases. FTS is much superior to conventional perioperative care. Our aim was to evaluate and compare the safety and efficacy of FTS and conventional perioperative care for patients undergoing gastrectomy using a systematic review.
  
  
  METHODS
  We searched the literature in PubMed, SCOPUS, and EMBASE up to November 2013. No language restriction was applied. Weighted mean differences (WMDs) and odds ratios (ORs) with their 95 % confidence intervals (CIs) were used for analysis by a fixed or a random effects model according to the heterogeneity assumption.
  
  
  RESULTS
  In the present meta-analysis, we included five randomized controlled trials and one controlled clinical trial from five studies. Compared with conventional care, FTS shortened the duration of flatus (WMD -21.08; 95 % CI -27.46 to -14.71, z = 6.48, p < 0.00001 in the open surgery group; WMD -8.20; 95 % CI -12.87 to -3.53, z = 3.44, p = 0.0006 in the laparoscopic surgery group), accelerated the decrease in C-reactive protein (WMD -15.56; 95 % CI 21.28 to 9.83, z = 5.33, p < 0.00001), shortened the postoperative stay (WMD -2.00; 95 % CI -2.69 to -1.30, z = 5.64, p < 0.00001), and reduced hospitalization costs (WMD -447.72; 95 % CI -615.92 to -279.51, z = 5.22, p < 0.00001). FTS made no significant difference in operation times (p = 0.93), intraoperative blood loss (p = 0.79), or postoperative complications (p = 0.07).
  
  
  CONCLUSIONS
  Based on current evidence, the FTS protocol was feasible for gastric cancer patients who underwent gastrectomy (distal subtotal gastrectomy, proximal subtotal gastrectomy, or radical total gastrectomy) via open or laparoscopic surgery. Larger studies are needed to validate our findings.
authors.affiliation: Department of Aerospace Medicine, Fourth Military Medical University, Xi'an, 710032, Shaanxi Province, China, yuanjunlee@126.com.
authors.forename: Yuan-Jun
authors.initials: YJ
authors.lastname: Li
authors.forename: Ting-Ting
authors.initials: TT
authors.lastname: Huo
authors.forename: Juan
authors.initials: J
authors.lastname: Xing
authors.forename: Jia-Ze
authors.initials: JZ
authors.lastname: An
authors.forename: Zhe-Yi
authors.initials: ZY
authors.lastname: Han
authors.forename: Xiao-Nan
authors.initials: XN
authors.lastname: Liu
authors.forename: Qing-Chuan
authors.initials: QC
authors.lastname: Zhao
mesh_terms: D016063:Blood Loss, Surgical; D002097:C-Reactive Protein / Q000378:metabolism; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D041981:Gastrointestinal Tract / Q000502:physiology; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay / Q000191:economics; D061646:Operative Time; D019990:Perioperative Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D013274:Stomach Neoplasms / Q000601:surgery*; D013997:Time Factors
chemical_list: D002097:C-Reactive Protein