Outcomes of enhanced recovery after surgery in lung cancer: A systematic review and meta-analysis

Objective: To assess the effect of ERAS on clinical prognosis in perioperative patients following lung cancer surgery. Methods: PubMed, Web of Science, MEDLINE, EMBASE, and other databases were systematically searched from inception to December 2021. Randomized controlled trials and peer-reviewed cohort studies on the use of ERAS in lung cancer surgery patients were included. Primary outcomes comprised visual analog scale scores after treatment and quality of life. Secondary outcomes comprised complication rate, function-related outcomes (chest tube indwelling time and first ambulation), and length of stay. Statistical analysis was performed using RevMan 5.4.1 software. Results: Finally, 23 studies were included (12 cohort studies and 11 randomized controlled trials) with a total of 8094 patients. Meta-analysis showed that ERAS significantly reduced visual analog scale scores (mean difference [MD] = -1.99, 95% confidence interval [CI] = -2.45, -1.54, P < 0.01), reduced the incidence of complications (odds ratio = 0.48, 95% CI = 0.37, 0.61, P < 0.01), shortened chest tube indwelling time (MD = -2.20, 95% CI = -2.75, -1.64, P < 0.01), accelerated first ambulation (MD = -1.48, 95% CI = -1.77, -1.19, P < 0.01), shortened length of stay (MD = -2.70, 95% CI = -3.05, -2.36, P < 0.01), and improved quality of life (MD = 10.3, 95% CI = 9.59, 11.02, P < 0.01). Conclusions: ERAS can accelerate postoperative recovery and improve quality of life. These findings support the use of ERAS as a standard of care for lung cancer surgery patients. However, the evidence quality was moderate and there were significant differences among studies. More high-quality studies incorporating relevant outcomes are needed for confirmation.