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      Application of enhanced recovery after surgery in partial nephrectomy for renal tumors: A systematic review and meta-analysis

      systematic-review

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          Abstract

          Objectives

          In recent years, enhanced recovery after surgery (ERAS) has been widely used in the field of urology, especially in radical cystectomy and radical prostatectomy, and has demonstrated its advantages. Although studies on the application of ERAS in partial nephrectomy for renal tumors are increasing, the conclusions are mixed, especially in terms of postoperative complications, etc, and its safety and efficacy are questionable. We conducted a systematic review and meta-analysis to assess the safety and efficacy of ERAS in the application of partial nephrectomy for renal tumors.

          Methods

          Pubmed, Embase, Cohrance library, Web of science and Chinese databases (CNKI, VIP, Wangfang and CBM) were systematically searched for all published literature related to the application of enhanced recovery after surgery in partial nephrectomy for renal tumors from the date of establishment to July 15, 2022, and the literature was screened by inclusion/exclusion criteria. The quality of the literature was evaluated for each of the included literature. This Meta-analysis was registered on PROSPERO (CRD42022351038) and data were processed using Review Manager 5.4 and Stata 16.0SE. The results were presented and analyzed by weighted mean difference (WMD), Standard Mean Difference (SMD) and risk ratio (RR) at their 95% confidence interval (CI). Finally, the limitations of this study are analyzed in order to provide a more objective view of the results of this study.

          Results

          This meta-analysis included 35 literature, including 19 retrospective cohort studies and 16 randomized controlled studies with a total of 3171 patients. The ERAS group was found to exhibit advantages in the following outcome indicators: postoperative hospital stay (WMD=-2.88, 95% CI: -3.71 to -2.05, p<0.001), total hospital stay (WMD=-3.35, 95% CI: -3.73 to -2.97, p<0.001), time to first postoperative bed activity (SMD=-3.80, 95% CI: -4.61 to -2.98, p < 0.001), time to first postoperative anal exhaust (SMD=-1.55, 95% CI: -1.92 to -1.18, p < 0.001), time to first postoperative bowel movement (SMD=-1.52, 95% CI: -2.08 to -0.96, p < 0.001), time to first postoperative food intake (SMD=-3.65, 95% CI: -4.59 to -2.71, p<0.001), time to catheter removal (SMD=-3.69, 95% CI: -4.61 to -2.77, p<0.001), time to drainage tube removal (SMD=-2.77, 95% CI: -3.41 to -2.13, p<0.001), total postoperative complication incidence (RR=0.41, 95% CI: 0.35 to 0.49, p<0.001), postoperative hemorrhage incidence (RR=0.41, 95% CI: 0.26 to 0.66, p<0.001), postoperative urinary leakage incidence (RR=0.27, 95% CI: 0.11 to 0.65, p=0.004), deep vein thrombosis incidence (RR=0.14, 95% CI: 0.06 to 0.36, p<0.001), and hospitalization costs (WMD=-0.82, 95% CI: -1.20 to -0.43, p<0.001).

          Conclusion

          ERAS is safe and effective in partial nephrectomy of renal tumors. In addition, ERAS can improve the turnover rate of hospital beds, reduce medical costs and improve the utilization rate of medical resources.

          Systematic review registration

          https://www.crd.york.ac.uk/PROSPERO, identifier CRD42022351038.

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          Most cited references57

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          Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.

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                Author and article information

                Contributors
                Journal
                Front Oncol
                Front Oncol
                Front. Oncol.
                Frontiers in Oncology
                Frontiers Media S.A.
                2234-943X
                09 February 2023
                2023
                : 13
                : 1049294
                Affiliations
                [1] 1 The First Clinical Medical College of Lanzhou University , Lanzhou, China
                [2] 2 The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital) , Lanzhou, China
                [3] 3 Department of Pediatrics, The First Affiliated Hospital of Bengbu Medical College , Bengbu, China
                [4] 4 Department of Urology, Gansu Provincial Hospital , Lanzhou, China
                Author notes

                Edited by: Michael Poch, Moffitt Cancer Center, United States

                Reviewed by: Wesley Yip, Memorial Sloan Kettering Cancer Center, United States; Sanja Štifter, Skejby Sygehus, Denmark

                *Correspondence: Zhou Fenghai, Zhoufengh@ 123456163.com

                †These authors have contributed equally to this work and share first authorship

                This article was submitted to Surgical Oncology, a section of the journal Frontiers in Oncology

                Article
                10.3389/fonc.2023.1049294
                9947501
                36845687
                6986a055-acc3-4e46-86c8-46c332fb43dd
                Copyright © 2023 Wangjian, Tianyi, Xiaoqian, Di, Chuan, Chao, Zijian, Tongtong and Fenghai

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 20 September 2022
                : 19 January 2023
                Page count
                Figures: 9, Tables: 4, Equations: 0, References: 57, Pages: 12, Words: 7247
                Categories
                Oncology
                Systematic Review

                Oncology & Radiotherapy
                renal tumors,partial nephrectomy,meta-analysis,enhanced recovery after surgery,systematic review

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