Fast track program in liver resection: A PRISMA-compliant systematic review and meta-analysis

---

Emad Ali Ahmed, Roberto Montalti, Daniele Nicolini, Paolo Vincenzi, Martina Coletta, Andrea Vecchi, Federico Mocchegiani and Marco Vivarelli

Polytechnic University of Marche, Italy
Sohag University, Egypt

: J Surg Clin Pract

Abstract

---

Background: FT program is a multi-modal approach used to enhance post-operative rehabilitations and accelerate recovery. It was firstly described in open heart surgery then modified to be feasible for different types of interventions including liver resection. Objective: To systematically review and Meta-analyse the impact of Fast track program (FT) use in patients underwent elective liver resection regarding to the main clinical and surgical outcomes compared to the traditional care (TC). Methods: An electronic search of PubMed/Medline, Scopus and Cochran databases was performed to identify articles comparing FT with TC in elective liver resection. Subgroup meta-analysis between laparoscopic and open surgical approaches was conducted. Results: From 2008 to 2015, three randomized controlled trials (RCTs) and five cohort studies were identified, including 394 patients in FT and 416 in the TC group. Length of hospital stay (LoS) was markedly shortened in both open and laparoscopic approaches within the FT program (overall P<0.00001). This reduced LoS is accompanied by accelerated functional recovery (P=0.0008) and decreased hospital costs with no increase in the readmission, morbidity or mortality rates. Significant results within FT group as reduced operative time (P=0.03) and intensive care unit admission rate (P<0.00001), early bowel opening (P=<0.00001) and restoration of normal diet (P=<0.00001) were also detected. Conclusion: FT program is considered safe, feasible and can be applied successfully in liver resection. Future RCTs focusing on debated issues as multimodal analgesia and adherence rate are needed. The development of specific FT guidelines in the field of liver resection is strongly recommended.

Biography

---

Emad Ali Ahmed has completed his Master degree at the age of 28 years from Sohag University and doctoral Studies from Polytechnic University of Marche, Italy. He has published about 9 papers in reputed journals and he is a reviewer for many international journals.

E-mail: dr.emadali@hotmail.com