title: Systematic review and meta-analysis for laparoscopic versus open colon surgery with or without an ERAS programme.
abstract: BACKGROUND
  In recent years, conventional colorectal resection and its aftercare have increasingly become replaced by laparoscopic surgery and enhanced recovery after surgery (ERAS) pathways, respectively.
  
  
  OBJECTIVE
  To ascertain whether combining laparoscopy and ERAS have additional value within colorectal surgery.
  
  
  METHODS
  A systematic review with meta-analysis was performed with two primary research questions; does laparoscopy offer an advantage when all patients receive ERAS perioperative care and does ERAS offer advantages in a laparoscopically operated patient population. All randomised and controlled clinical trials were identified using MEDLINE, EMBASE and Cochrane databases.
  
  
  RESULTS
  Primary search resulted in 319 hits. After inclusion criteria were applied, three RCTs and six CCTs were included in the meta-analysis. For laparoscopically operated patients with/without ERAS, no differences in morbidity were found and postoperative hospital stay favoured ERAS (MD -2.34 [-3.77, -0.91], Z = 3.20, p = 0.001). When comparing laparoscopy and open surgery within ERAS, major morbidity was significantly reduced in the laparoscopic group (OR 0.42 [0.26, 0.66], Z = 3.73, p = 0.006). Other outcome parameters showed no differences. Quality of included studies was considered moderate to poor overall with small sample sizes.
  
  
  CONCLUSIONS
  When laparoscopy and ERAS are combined, major morbidity and hospital stay are reduced. The reduction in morbidity seems to be due to laparoscopy rather than ERAS, so laparoscopy by itself offers independent advantages beyond ERAS care. Quality of included studies was moderate to poor, so conclusions should be regarded with some reservations.
authors: Department of Surgery, Radboud University Medical Centre, Huispost 690, Postbus 9101, 6500 HB, Nijmegen, The Netherlands. richard.spanjersberg@radboudumc.nl.
authors: W R
authors: WR
authors: Spanjersberg
authors: Department of Surgery, Radboud University Medical Centre, Huispost 690, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
authors: J D P
authors: JD
authors: van Sambeeck
authors: Department of Surgery, Radboud University Medical Centre, Huispost 690, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
authors: A
authors: A
authors: Bremers
authors: Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
authors: C
authors: C
authors: Rosman
authors: Department of Surgery, Radboud University Medical Centre, Huispost 690, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
authors: C J H M
authors: CJ
authors: van Laarhoven
mesh_terms: D002986:Clinical Trials as Topic; D003108:Colonic Diseases / Q000601:surgery*; D003107:Colorectal Surgery / Q000379:methods*; D013505:Digestive System Surgical Procedures; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D019990:Perioperative Care / Q000379:methods*
keywords: Colon surgery; ERAS; Laparoscopic surgery; Meta-analysis; Systematic review