A pooled analysis of fast track procedure vs. conventional care in laparoscopic colorectal cancer surgery

Fast track (FT) procedure has proposed to accelerate recovery, reduce morbidity and shorten hospital stay. The aim of this review was to compare the safety and effectiveness of the FT procedure with that of conventional care in laparoscopic colorectal resection. A systematic literature search for relevant articles was conducted in PUBMED, EMBASE and Cochrane Library digital databases. The main endpoints were the duration of postoperative hospital stay, time to first flatus, time of first bowel movement, postoperative complication rate, readmission rate, and mortality. A total of 1317 patients from 10 studies (5 RCTs and 5 CCTs) were included. Compared with the conventional care, FT procedure reduced the postoperative hospital stay (weighted mean difference [WMD] -0.65; 95% CI: -0.76, -0.53), time to first flatus (WMD: -1.91; 95% CI: -3.31, -0.5), time to first bowel movement (WMD: -0.70; 95% CI: -0.85, -0.55), and total postoperative complication rate (RR=0.73; 95% CI: 0.60, 0.88), but there was no significant difference in the readmission rate (RR=0.66; 95% CI, 0.42, 1.05) and mortality (RR=1.53; 95% CI, 0.42, 5.66). FT procedure for laparoscopic colorectal resection is safe and efficacious. Nevertheless, more international multicenter prospective large sample RCTs are needed to determine the advantages of this approach.