title: Fast track program in liver resection: a PRISMA-compliant systematic review and meta-analysis.
abstract: BACKGROUND
  FT program (FT) is a multimodal approach used to enhance postoperative rehabilitation and accelerate recovery. It was 1st described in open heart surgery, then modified and applied successfully in colorectal surgery. FT program was described in liver resection for the 1st time in 2008. Although the program has become widely accepted, it has not yet been considered the standard of care in liver surgery.
  
  
  OBJECTIVE
  we performed this systematic review and meta-analysis to evaluate the impact of using the FT program compared to the traditional care (TC), on the main clinical and surgical outcomes for patients who underwent elective liver resection.
  
  
  METHODS
  PubMed/Medline, Scopus, and Cochran databases were searched to identify eligible articles that compared FT with TC in elective liver resection to be included in this study. Subgroup meta-analysis between laparoscopic and open surgical approaches to liver resection was also conducted. Quality assessment was performed for all the included studies. Odds ratios (ORs) and mean differences (MDs) were considered as a summary measure of evaluating the association in this meta-analysis for dichotomous and continuous data, respectively. A 95% confidence interval (CI) was reported for both measures. I was used to assess the heterogeneity across studies.
  
  
  RESULTS
  From 2008 to 2015, 3 randomized controlled trials (RCTs) and 5 cohort studies were identified, including 394 and 416 patients in the FT and TC groups, respectively. The length of hospital stay (LoS) was markedly shortened in both the open and laparoscopic approaches within the FT program (P < 0.00001). The reduced LoS was accompanied by accelerated functional recovery (P = 0.0008) and decreased hospital costs, with no increase in readmission, morbidity, or mortality rates. Moreover, significant results were found within the FT group such as reduced operative time (P = 0.03), lower intensive care unit admission rate (P < 0.00001), early bowel opening (P ≤ 0.00001), and rapid normal diet restoration (P ≤ 0.00001).
  
  
  CONCLUSIONS
  FT program is safe, feasible, and can be applied successfully in liver resection. Future RCTs on controversial issues such as multimodal analgesia and adherence rate are needed. Specific FT guidelines should be developed for liver resection.
authors.affiliation: Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy Hepatobiliary and Pancreatic Surgery Unit, General Surgery Department, Sohag University, Sohag, Egypt.
authors.forename: Emad Ali
authors.initials: EA
authors.lastname: Ahmed
authors.forename: Roberto
authors.initials: R
authors.lastname: Montalti
authors.forename: Daniele
authors.initials: D
authors.lastname: Nicolini
authors.forename: Paolo
authors.initials: P
authors.lastname: Vincenzi
authors.forename: Martina
authors.initials: M
authors.lastname: Coletta
authors.forename: Andrea
authors.initials: A
authors.lastname: Vecchi
authors.forename: Federico
authors.initials: F
authors.lastname: Mocchegiani
authors.forename: Marco
authors.initials: M
authors.lastname: Vivarelli
mesh_terms: D019091:Critical Pathways; D006498:Hepatectomy; D006801:Humans; D007902:Length of Stay; D008107:Liver Diseases / Q000601:surgery*; D020127:Recovery of Function; D016896:Treatment Outcome