Efficacy and safety of fast track surgery in adrenalectomy: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Haiyan ,  WANG Li , ZHU Bili , LI Yumei

Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, P.R.China;

Corresponding author：

WANG Li, Email: 379157401@qq.com

Keywords：

Adrenalectomy; Fast track surgery; Perioperative period; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.201904010

Video：

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Objectives To systematically review the efficacy and safety of fast track surgery in perioperative patients with adrenalectomy.Methods PubMed, EMbase, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of fast track surgery in perioperative patients with adrenalectomy from inception to January 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 11 RCTs involving 1 034 patients were included. The results of meta-analysis showed that: fast track surgery in perioperative patients with adrenalectomy could shorten first exhaust time (MD=−17.16, 95%CI −21.86 to −12.46, P<0.000 01), postoperative catheter indwelling time (MD=−43.44, 95%CI −46.65 to −40.23, P<0.000 01) and drainage tube indwelling time (MD=−39.91, 95%CI −57.58 to −22.23, P<0.000 01), and reduce the incidence of complications after adrenalectomy (OR=0.26, 95%CI 0.1 to 0.39, P<0.000 01). There were no statistically differences in operation time (MD=−1.18, 95%CI −3.22 to 0.86, P=0.26) and blood loss (MD=0.25, 95%CI −2.84 to 3.34, P=0.88) between two groups.Conclusions Current evidence shows that, compared with the conventional rehabilitation group, fast track surgery can promote postoperative recovery of patients with adrenalectomy more safely and effectively, which has clinical promotion value. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.

Citation： WANG Haiyan, WANG Li, ZHU Bili, LI Yumei. Efficacy and safety of fast track surgery in adrenalectomy: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(10): 1211-1216. doi: 10.7507/1672-2531.201904010 Copy

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2.	Gemmill EH, Humes DJ, Catton JA. Systematic review of enhanced recovery after gastro-oesophageal cancer surgery. Ann R Coll Surg Engl, 2015, 97(3): 173-179.
3.	Tang CP, Xu ZY, Yi XM, et al. Fast track surgery vs. conventional management in the perioperative care of retroperitoneal laparoscopic adrenalectomy. Int J Clin Exp Med, 2015, 8(9): 16207-16214.
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9.	梁伟霞, 苏蕾, 韦颖, 等. 快速康复护理在腹腔镜治疗肾上腺疾病中的应用. 微创医学, 2014, 9(6): 800-801.
10.	张其强, 赵海卫, 张学宝, 等. 加速康复外科在后腹腔镜肾上腺切除术中的应用. 国际泌尿系统杂志, 2018, 38(5): 785-788.
11.	许露伟, 周六化. 快速康复外科技术在经腹腹腔镜肾上腺肿瘤切除术围手术期的临床应用. 山西医药杂志, 2017, 46(20): 2459-2461.
12.	阎淑芹, 李静. 加速康复外科运用于后腹腔镜肾上腺切除术的安全性及有效性研究. 护理实践与研究, 2015, 12(10): 47-48.
13.	陈惠洪, 陈琴珠, 林争艳. 快速康复外科护理在后腹腔镜下肾上腺手术病人围术期中的应用. 全科护理, 2017, 15(21): 2561-2564.
14.	赵俊智. 围手术期患者的心理护理. 中国医药指南, 2012, 10(16): 345-346.
15.	Stergiopoulou A, Birbas K, Katostaras T, et al. The effect of interactive multimedia on preoperative knowledge and postoperative recovery of patients undergoing laparoscopic cholecystectomy. Methods Inf Med, 2007, 46(4): 406-409.
16.	Slim K, Vicaut E, Launay-Savary MV, et al. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg, 2009, 249(2): 203-209.
17.	Andersen HK, Lewis SJ, Thomas S. Early enteral nutrition within 24 h of eolorectal surgry versus later commencement of feeding for postoperative complications. Cochrane Database Syst Rev, 2006, (4): CD004080.
18.	张静, 孙梅林, 李飞. 综合性保温措施在快速康复外科后腹腔镜下肾上腺切除术中的应用. 中国医学创新, 2017, 14(3): 89-92.
19.	郭振, 李幼生. 围手术期液体治疗在结直肠快通道外科中的应用. 医学研究生学报, 2011, 24(9): 993-996.
20.	Hübner M, Schäfer M, Demartines N, et al. Impact of restrictive intravenous fluid replacement and combined epidural analgesia on perioperative volume balance and renal function within a Fast Track program. J Surg Res, 2012, 173(1): 68-74.
21.	Zhao JH, Sun JX, Huang XZ, et al. Meta-analysis of the laparoscopic versus open colorectal surgery within fast track surgery. Int J Colorectal Dis, 2016, 31(3): 613-622.
22.	刘晶晶, 鲁嘉驹, 师将, 等. 快速康复外科在食管癌手术患者中应用效果的系统评价与 Meta 分析. 中国胸心血管外科临床杂志, 2018, 25(7): 596-603.
23.	结直肠手术应用加速康复外科中国专家共识(2015 版). 中华胃肠外科杂志, 2015, 18(8): 785-787.
24.	Nygren J, Thacker J, Carli F, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Clin Nutr, 2012, 31(6): 801-816.
25.	Lassen K, Coolsen MM, Slim K, et al. Guidelines for perioperative care for pancreaticoduoden-ectomy: Enhanced Recovery After Surgery (ERAS) Society recommendations. Clin Nutr, 2012, 31(6): 817-830.
26.	Maffezzini M, Campodonico F, Capponi G, et al. Fast-track surgery and technical nuances to reduce complications after radical cystectomy and intestinal urinary diversion with the modified Indiana pouch. Surg Oncol, 2012, 21(3): 191-195.

1. Wainwright TW, Immins T, Middleton RG. Enhanced recovery after surgery (ERAS) and its applicability for major spine surgery. Best Pract Res Clin Anaesthesiol, 2016, 30(1): 91-102.
2. Gemmill EH, Humes DJ, Catton JA. Systematic review of enhanced recovery after gastro-oesophageal cancer surgery. Ann R Coll Surg Engl, 2015, 97(3): 173-179.
3. Tang CP, Xu ZY, Yi XM, et al. Fast track surgery vs. conventional management in the perioperative care of retroperitoneal laparoscopic adrenalectomy. Int J Clin Exp Med, 2015, 8(9): 16207-16214.
4. 唐朝朋, 徐振宇, 高建平, 等. 加速康复外科在后腹腔镜肾上腺切除术中的应用. 医学研究生学报, 2014, 27(8): 829-832.
5. 孙梅林, 丁萍, 张静, 等. 快速康复外科护理在后腹腔镜下肾上腺切除术中的应用观察. 护理研究, 2016, 30(13): 1622-1625.
6. 尹文文, 丁华, 侯翠翠, 等. 快速康复外科理念在后腹腔镜下肾上腺肿瘤切除术围术期中的应用. 微创泌尿外科杂志, 2016, 5(1): 52-55.
7. 董雅琪, 杨利英. 快速康复外科理念在后腹腔镜下肾上腺肿瘤切除术围术期护理中的应用. 全科护理, 2018, 16(4): 402-404.
8. 李剑梅. 快速康复外科护理在后腹腔镜下肾上腺切除术中的应用分析. 临床医药文献电子杂志, 2017, 4(96): 18906-18907.
9. 梁伟霞, 苏蕾, 韦颖, 等. 快速康复护理在腹腔镜治疗肾上腺疾病中的应用. 微创医学, 2014, 9(6): 800-801.
10. 张其强, 赵海卫, 张学宝, 等. 加速康复外科在后腹腔镜肾上腺切除术中的应用. 国际泌尿系统杂志, 2018, 38(5): 785-788.
11. 许露伟, 周六化. 快速康复外科技术在经腹腹腔镜肾上腺肿瘤切除术围手术期的临床应用. 山西医药杂志, 2017, 46(20): 2459-2461.
12. 阎淑芹, 李静. 加速康复外科运用于后腹腔镜肾上腺切除术的安全性及有效性研究. 护理实践与研究, 2015, 12(10): 47-48.
13. 陈惠洪, 陈琴珠, 林争艳. 快速康复外科护理在后腹腔镜下肾上腺手术病人围术期中的应用. 全科护理, 2017, 15(21): 2561-2564.
14. 赵俊智. 围手术期患者的心理护理. 中国医药指南, 2012, 10(16): 345-346.
15. Stergiopoulou A, Birbas K, Katostaras T, et al. The effect of interactive multimedia on preoperative knowledge and postoperative recovery of patients undergoing laparoscopic cholecystectomy. Methods Inf Med, 2007, 46(4): 406-409.
16. Slim K, Vicaut E, Launay-Savary MV, et al. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg, 2009, 249(2): 203-209.
17. Andersen HK, Lewis SJ, Thomas S. Early enteral nutrition within 24 h of eolorectal surgry versus later commencement of feeding for postoperative complications. Cochrane Database Syst Rev, 2006, (4): CD004080.
18. 张静, 孙梅林, 李飞. 综合性保温措施在快速康复外科后腹腔镜下肾上腺切除术中的应用. 中国医学创新, 2017, 14(3): 89-92.
19. 郭振, 李幼生. 围手术期液体治疗在结直肠快通道外科中的应用. 医学研究生学报, 2011, 24(9): 993-996.
20. Hübner M, Schäfer M, Demartines N, et al. Impact of restrictive intravenous fluid replacement and combined epidural analgesia on perioperative volume balance and renal function within a Fast Track program. J Surg Res, 2012, 173(1): 68-74.
21. Zhao JH, Sun JX, Huang XZ, et al. Meta-analysis of the laparoscopic versus open colorectal surgery within fast track surgery. Int J Colorectal Dis, 2016, 31(3): 613-622.
22. 刘晶晶, 鲁嘉驹, 师将, 等. 快速康复外科在食管癌手术患者中应用效果的系统评价与 Meta 分析. 中国胸心血管外科临床杂志, 2018, 25(7): 596-603.
23. 结直肠手术应用加速康复外科中国专家共识(2015 版). 中华胃肠外科杂志, 2015, 18(8): 785-787.
24. Nygren J, Thacker J, Carli F, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Clin Nutr, 2012, 31(6): 801-816.
25. Lassen K, Coolsen MM, Slim K, et al. Guidelines for perioperative care for pancreaticoduoden-ectomy: Enhanced Recovery After Surgery (ERAS) Society recommendations. Clin Nutr, 2012, 31(6): 817-830.
26. Maffezzini M, Campodonico F, Capponi G, et al. Fast-track surgery and technical nuances to reduce complications after radical cystectomy and intestinal urinary diversion with the modified Indiana pouch. Surg Oncol, 2012, 21(3): 191-195.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of fast track surgery in adrenalectomy: a meta-analysis

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