PROSPERO

International prospective register of systematic reviews

Enhanced recovery after surgery (ERAS) programs for patients undergoing esophageal
surgery: a systematic review and meta-analysis
Wei Wang, Feiyu Liu, Chaoyang Wang, Xiaonu Peng, Chengde Wang

Citation
Wei Wang, Feiyu Liu, Chaoyang Wang, Xiaonu Peng, Chengde Wang. Enhanced recovery after
surgery (ERAS) programs for patients undergoing esophageal surgery: a systematic review and
meta-analysis. PROSPERO 2018 CRD42018085977 Available from:
http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018085977

Review question
Enhanced Recovery After Surgery (ERAS) programs are well established in many surgical specialties,
conducting decrease in morbidity and duration of hospital stay. This review aimed to evaluate current
literature on ERAS in esophageal cancer surgery and perform a meta-analysis on primary and secondary
outcomes.

Searches
We will perform a systematic literature search through December 2017 using EMBASE, MEDLINE via
PubMed, the Cochrane Central Register of Controlled Trials and Google Scholar for relevant articles
published in any language.
The search strategy will be built using a combination of the following key search terms:
esophagus, esophageal, esophagectomy, oesophagectomy, esophageal resection, esophagus resection,
transthoracic, transhiatal, open, minimally, robot assist, robotic, thoracoscopic, laparoscopic, laparoscopical,
laparoscopically, IvorLewis, ERAS, fast track, enhanced recovery, clinical pathway, critical pathway,
multimodal perioperative and perioperative protocol.

Types of study to be included

Randomized controlled trials (RCTs) , prospective comparative cohort studies
Animal studies, meeting abstracts, letters/comments/editorials will be excluded.

Condition or domain being studied

Surgical treatment for resectable esophageal cancer.

Participants/population
Adult patients with resectable esophageal cancer.

Intervention(s), exposure(s)
Enhanced recovery after surgery programs in treatment of esophageal cancer patients.

Comparator(s)/control
Conventional standard care.

Primary outcome(s)
Overall morbidity.

Secondary outcome(s)
Surgical complications, non-surgical complications, length of hospital stay, 30-day readmission rate.

Data extraction (selection and coding)

Risk of bias (quality) assessment

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International prospective register of systematic reviews

Three review authors (WW, FYL, CDW) will independently assess the risk of bias for each study using the
criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. Any disagreements will
be resolved by discussion or by involving another review author (CYW or XNP). The risk of bias will be
assessed according to the following domains: 1. Random sequence generation. 2. Allocation concealment.
3. Blinding of participants and personnel. 4. Blinding of outcome assessment. 5. Incomplete outcome data. 6.
Selective outcome reporting. 7. Other bias.

Each potential source of bias will be graded as high, low or unclear and a quote from the study report with a
justification for our judgement will be provided in the 'Risk of bias' table. The risk of bias judgements across
different studies for each of the domains listed will be summarised.

Strategy for data synthesis

A quantitative analysis is planned, and the data synthesis will be presented in tables or written in text in the
result section. We will pool data from studies we judge to be clinically homogeneous using ReviewManager 5
software.

Statistical heterogeneity between studies will be tested with I² statistics. An I² value of 50-75% is defined as
substantial heterogeneity and an I² >=75% is defined as considerable heterogeneity.

In case of questions, missing data or uncertainty the authors will be contacted.

Sensitivity analysis will be performed using quality scoring.

Publication bias will be explored by funnel plotting.

The Mantel-Haenszel method will be applied for pooling of dichotomous data and results will be presented as
relative risk (RR) with their 95% confidence intervals (CI). A p-value<0.05 will be considered significant.
Inverse variance method will be used for pooling of continuous data and results will be presented as
standardized mean difference (SMD) with their 95% CI. Heterogeneity will be explored by Cochran's test.
Significance was set at p-value 0.10, and the quantity of heterogeneity was measured by I². A fixed-effect
model will be applied for meta-analysis. In the presence of significant statistical heterogeneity, a random-
effects model will be used.

Analysis of subgroups or subsets

A planned exploration of subgroups will be done for the following groups separately:
minimally invasive esophagectomy, open invasive esophagectomy, hybrid approach esophagectomy.

Contact details for further information

Wei Wang
Wongwea@hotmial.com

Organisational affiliation of the review

Yantai Yuhuangding Hospital

Review team members and their organisational affiliations

Dr Wei Wang. Yantai Yuhuangding Hospital
Dr Feiyu Liu. Yantai Yuhuangding Hospital
Dr Chaoyang Wang. Yantai Yuhuangding Hospital
Dr Xiaonu Peng. Yantai Yuhuangding Hospital
Dr Chengde Wang. Yantai Yuhuangding Hospital

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International prospective register of systematic reviews

Anticipated or actual start date

05 January 2018

Anticipated completion date

31 December 2018

Funding sources/sponsors
None

Conflicts of interest
Language
English

Country
China

Stage of review
Review_Ongoing

Subject index terms status

Subject indexing assigned by CRD

Subject index terms

Humans; Length of Stay; Perioperative Care

Date of registration in PROSPERO

23 January 2018

Date of publication of this version

23 January 2018

Details of any existing review of the same topic by the same authors
Stage of review at time of this submission

Stage Started Completed

Preliminary searches Yes No

Piloting of the study selection process No No

Formal screening of search results against eligibility criteria No No

Data extraction No No

Risk of bias (quality) assessment No No

Data analysis No No

Versions
23 January 2018

PROSPERO
This information has been provided by the named contact for this review. CRD has accepted this information in good

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 PROSPERO
International prospective register of systematic reviews

faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration
record, any associated files or external websites.

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