Effect of prehabilitation on outcomes in patients undergoing elective gastrointestinal surgery: a systematic review

doi:10.3969/j.issn.1674-8115.2023.01.009

Abstract

Abstract:

Objective ·To systematically evaluate the effect of prehabilitation on outcomes in patients undergoing elective gastrointestinal surgery. Methods ·PubMed, EMbase, Cochrane Library, Web of Science, CINAHL, Chinese BioMedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang and VIP Database were searched systematically from the establishment of each database to January 31, 2022. The literatures were screened, and evaluated according to the preset inclusion and exclusion criteria. The literature quality was evaluated and the data were extracted. Meta-analysis was performed on randomized controlled trials by using RevMan 5.4. The main observation indexes were the postoperative complication rate and the incidence of surgical site infection. The secondary indexes were hospitalization days, 6-minute walk test (6MWT), Hospital Anxiety and Depression Scale (HADS) score, mortality and compliance of prerehabilitation execution. Results ·Sixteen articles were included, including 15 articles in English and 1 article in Chinese, with a total of 1 616 patients. The overall quality of the included researches was good. The meta-analysis results showed that compared with the control group, the incidences of postoperative complications and surgical site infection were reduced [(odds ratio, OR)=0.57, 95% (confidence interval, CI)0.35?0.94, P=0.030; OR=0.64, 95%CI 0.46?0.90, P=0.009]; the length of hospital stay was shortened [mean difference (MD)=-2.45, 95%CI -3.17 ? -1.73, P=0.000] in the experimental group after the implementation of prehabilitation. There was no significant difference in preoperative 6MWT level between the two groups. Compared with the baseline, the change of 6MWT level before operation of the experimental group was bigger than that of the control group (MD=24.19, 95%CI 3.77?44.60, P=0.020). There were no significant differences in the preoperative HADS score and the postoperative mortality between the two groups. Conclusion ·Prehabilitation can reduce the incidence of postoperative complications, especially surgical site infection, in patients undergoing elective gastrointestinal surgery, thus shortening the length of hospital stay and promoting the recovery of patients.

Key words: gastrointestinal surgery, prehabilitation, postoperative recovery, systematic review, meta-analysis

CLC Number:

R473.6

FANG Fang, TAI Rui, YU Qian, ZHANG Yaqing. Effect of prehabilitation on outcomes in patients undergoing elective gastrointestinal surgery: a systematic review[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(1): 70-78.

Figures/Tables 7

TrendMD

References 40

1	MCDERMOTT F D, HEENEY A, KELLY M E, et al. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks[J]. Br J Surg, 2015, 102(5): 462-479.
2	GOVAERT J A, FIOCCO M, VAN DIJK W A, et al. Costs of complications after colorectal cancer surgery in the Netherlands: building the business case for hospitals[J]. Eur J Surg Oncol, 2015, 41(8): 1059-1067.
3	KIRCHHOFF P, CLAVIEN P A, HAHNLOSER D. Complications in colorectal surgery: risk factors and preventive strategies[J]. Patient Saf Surg, 2010, 4(1): 5.
4	GUSTAFSSON U O, SCOTT M J, HUBNER M, et al. Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS^®) society recommendations: 2018[J]. World J Surg, 2019, 43(3): 659-695.
5	CARLI F, BESSISSOW A, AWASTHI R, et al. Prehabilitation: finally utilizing frailty screening data[J]. Eur J Surg Oncol, 2020, 46(3): 321-325.
6	LI C, CARLI F, LEE L, et al. Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study[J]. Surg Endosc, 2013, 27(4): 1072-1082.
7	CARLI F, BOUSQUET-DION G, AWASTHI R, et al. Effect of multimodal prehabilitation vs postoperative rehabilitation on 30-day postoperative complications for frail patients undergoing resection of colorectal cancer: a randomized clinical trial[J]. JAMA Surg, 2020, 155(3): 233-242.
8	LE ROY B, SLIM K. Is prehabilitation limited to preoperative exercise?[J]. Surgery, 2017, 162(1): 192.
9	CLAVIEN P A, BARKUN J, DE OLIVEIRA M L, et al. The Clavien-Dindo classification of surgical complications: five-year experience[J]. Ann Surg, 2009, 250(2): 187-196.
10	胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018.
	HU Y, HAO Y F. Evidence-based nursing[M]. 2nd ed. Beijing: People′s Medical Publishing House, 2018.
11	LÓPEZ-RODRÍGUEZ-ARIAS F, SÁNCHEZ-GUILLÉN L, ARANAZ-OSTÁRIZ V, et al. Effect of home-based prehabilitation in an enhanced recovery after surgery program for patients undergoing colorectal cancer surgery during the COVID-19 pandemic[J]. Support Care Cancer, 2021, 29(12): 7785-7791.
12	BARBERAN-GARCIA A, UBRÉ M, ROCA J, et al. Personalised prehabilitation in high-risk patients undergoing elective major abdominal surgery: a randomized blinded controlled trial[J]. Ann Surg, 2018, 267(1): 50-56.
13	BOUSQUET-DION G, AWASTHI R, LOISELLE S È, et al. Evaluation of supervised multimodal prehabilitation programme in cancer patients undergoing colorectal resection: a randomized control trial[J]. Acta Oncol, 2018, 57(6): 849-859.
14	OMMUNDSEN N, WYLLER T B, NESBAKKEN A, et al. Preoperative geriatric assessment and tailored interventions in frail older patients with colorectal cancer: a randomized controlled trial[J]. Colorectal Dis, 2018, 20(1): 16-25.
15	BURDEN S T, GIBSON D J, LAL S, et al. Pre-operative oral nutritional supplementation with dietary advice versus dietary advice alone in weight-losing patients with colorectal cancer: single-blind randomized controlled trial[J]. J Cachexia Sarcopenia Muscle, 2017, 8(3): 437-446.
16	GILLIS C, LOISELLE S E, FIORE J F J R, et al. Prehabilitation with whey protein supplementation on perioperative functional exercise capacity in patients undergoing colorectal resection for cancer: a pilot double-blinded randomized placebo-controlled trial[J]. J Acad Nutr Diet, 2016, 116(5): 802-812.
17	GILLIS C, LI C, LEE L, et al. Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer[J]. Anesthesiology, 2014, 121(5): 937-947.
18	FUJITANI K, TSUJINAKA T, FUJITA J, et al. Prospective randomized trial of preoperative enteral immunonutrition followed by elective total gastrectomy for gastric cancer[J]. Br J Surg, 2012, 99(5): 621-629.
19	BURDEN S T, HILL J, SHAFFER J L, et al. An unblinded randomised controlled trial of preoperative oral supplements in colorectal cancer patients[J]. J Hum Nutr Diet, 2011, 24(5): 441-448.
20	SMEDLEY F, BOWLING T, JAMES M, et al. Randomized clinical trial of the effects of preoperative and postoperative oral nutritional supplements on clinical course and cost of care[J]. Br J Surg, 2004, 91(8): 983-990.
21	GIANOTTI L, BRAGA M, NESPOLI L, et al. A randomized controlled trial of preoperative oral supplementation with a specialized diet in patients with gastrointestinal cancer[J]. Gastroenterology, 2002, 122(7): 1763-1770.
22	BRAGA M, GIANOTTI L, NESPOLI L, et al. Nutritional approach in malnourished surgical patients: a prospective randomized study[J]. Arch Surg, 2002, 137(2): 174-180.
23	KABATA P, JASTRZĘBSKI T, KĄKOL M, et al. Preoperative nutritional support in cancer patients with no clinical signs of malnutrition: prospective randomized controlled trial[J]. Support Care Cancer, 2015, 23(2): 365-370.
24	BARKER L A, GRAY C, WILSON L, et al. Preoperative immunonutrition and its effect on postoperative outcomes in well-nourished and malnourished gastrointestinal surgery patients: a randomised controlled trial[J]. Eur J Clin Nutr, 2013, 67(8): 802-807.
25	BERKEL A E M, BONGERS B C, KOTTE H, et al. Effects of community-based exercise prehabilitation for patients scheduled for colorectal surgery with high risk for postoperative complications: results of a randomized clinical trial[J]. Ann Surg, 2022, 275(2): e299-e306.
26	黄正接, 陈百胜, 尤俊, 等. 胃肠道恶性肿瘤术前肠内免疫营养支持的临床意义[J]. 四川大学学报(医学版), 2014, 45(1): 167-170.
	HUANG Z J, CHEN B S, YOU J, et al. The clinical significance of preoperative enteral immune nutrition in patients with malignant gastrointestinal tumors[J]. Journal of Sichuan University (Medical Sciences), 2014, 45(1): 167-170.
27	周岩冰. 胃肠肿瘤患者的术前预康复[J]. 中华胃肠外科杂志, 2021, 24(2): 122-127.
	ZHOU Y B. Prehabilitation for gastrointestinal cancer patients[J]. Chinese Journal of Gastrointestinal Surgery, 2021, 24(2): 122-127.
28	ADIAMAH A, SKOŘEPA P, WEIMANN A, et al. The impact of preoperative immune modulating nutrition on outcomes in patients undergoing surgery for gastrointestinal cancer: a systematic review and meta-analysis[J]. Ann Surg, 2019, 270(2): 247-256.
29	REECE L, DRAGICEVICH H, LEWIS C, et al. Preoperative nutrition status and postoperative outcomes in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy[J]. Ann Surg Oncol, 2019, 26(8): 2622-2630.
30	吴秀文, 张旭飞, 阳怡羽, 等. 2018—2020年中国结直肠术后手术部位感染现状研究[J]. 中华胃肠外科杂志, 2022, 25(9): 804-811.
	WU X W, ZHANG X F, YANG Y Y, et al. Surgical site infection after colorectal surgery in China from 2018 to 2020[J]. Chinese Journal of Gastrointestinal Surgery, 2022, 25(9): 804-811.
31	匡荣康, 王成龙, 强光辉, 等. 营养状态对结直肠癌病人手术部位感染的影响及相关因素分析[J]. 肠外与肠内营养, 2021, 28(2): 84-87.
	KUANG R K, WANG C L, QIANG G H, et al. Analysis of the influencing factors for SSI in colorectal cancer patients with different nutrition disorder[J]. Parenteral & Enteral Nutrition, 2021, 28(2): 84-87.
32	张芳芳, 胡雅静, 黄华勇, 等. 基于CT诊断的肌少症对结直肠癌患者发生手术部位感染的影响因素分析[J]. 中国全科医学, 2022, 25(29): 3658-3663.
	ZHANG F F, HU Y J, HUANG H Y, et al. Association of CT-assessed sarcopenia with postoperative surgical site infections in patients with colorectal cancer[J]. Chinese General Practice, 2022, 25(29): 3658-3663.
33	GILLIS C, BUHLER K, BRESEE L, et al. Effects of nutritional prehabilitation, with and without exercise, on outcomes of patients who undergo colorectal surgery: a systematic review and meta-analysis[J]. Gastroenterology, 2018, 155(2): 391-410.e4.
34	YANG J, ZHANG T, FENG D, et al. A new diagnostic index for sarcopenia and its association with short-term postoperative complications in patients undergoing surgery for colorectal cancer[J]. Colorectal Dis, 2019, 21(5): 538-547.
35	MALIETZIS G, JOHNS N, AL-HASSI H O, et al. Low muscularity and myosteatosis is related to the host systemic inflammatory response in patients undergoing surgery for colorectal cancer[J]. Ann Surg, 2016, 263(2): 320-325.
36	MALIETZIS G, CURRIE A C, JOHNS N, et al. Skeletal muscle changes after elective colorectal cancer resection: a longitudinal study[J]. Ann Surg Oncol, 2016, 23(8): 2539-2547.
37	PECORELLI N, FIORE J F JR, GILLIS C, et al. The six-minute walk test as a measure of postoperative recovery after colorectal resection: further examination of its measurement properties[J]. Surg Endosc, 2016, 30(6): 2199-2206.
38	MOUG S J, BARRY S J E, MAGUIRE S, et al. Does prehabilitation modify muscle mass in patients with rectal cancer undergoing neoadjuvant therapy? A subanalysis from the REx randomised controlled trial[J]. Tech Coloproctol, 2020, 24(9): 959-964.
39	XU L, PAN Q, LIN R. Prevalence rate and influencing factors of preoperative anxiety and depression in gastric cancer patients in China: preliminary study[J]. J Int Med Res, 2016, 44(2): 377-388.
40	VAN ROOIJEN S, CARLI F, DALTON S, et al. Multimodal prehabilitation in colorectal cancer patients to improve functional capacity and reduce postoperative complications: the first international randomized controlled trial for multimodal prehabilitation[J]. BMC Cancer, 2019, 19(1): 98.

Study	Population	Sample size （I/C）	Intervention method	Control method	Follow-up	Outcome
LÓPEZ-RODRÍGUEZ-ARIAS， 2021^［11］	Adults， elective surgery for colon or rectal neoplasm	10/10	A 30-d trimodal prehabilitation program with recommendations on physical exercise， nutritional supplementation， and relaxation exercises to be performed at home before surgery and the first 30 d after hospital discharge	Standard care	12 weeks postoper-ative	①②⑥
BARBERAN-GARCIA， 2018^［12］	Adults， elective major abdominal surgery with high risk	62/63	A personalized prehabilitation program based on their health conditions and social circumstances which encompassed 3 major steps： motivational interview to assess the patients′ adherence profile and to codesign the characteristics of the physical activity program with the patient； personalized program to promote daily physical activity； supervised high-intensity endurance exercise training program	Standard care	Before discharge	①②③ ④⑤⑥
BOUSQUET-DION， 2018^［13］	Adults， elective surgery for colon or rectal neoplasm	37/26	A 4-week multi-modal home-based exercise program with once-weekly supervision consisted of exercise intervention， nutritional intervention and anxiety-reduction strategies	Standard care	8 weeks postoper-ative	①②③ ④⑥⑦
OMMUNDSEN， 2018^［14］	>65 years， elective colorectal cancer surgery and fulfilling predefined criteria for frailty	53/63	A 3-week pragmatic tailored intervention based on the results of the geriatric assessment	Standard care	3 months postoper-ative	①②⑤ ⑥
BURDEN， 2017^［15］	Adults， elective colorectal cancer surgery with preoperative weight loss>1 kg per 3‒6 months	55/45	Oral supplementation （10.1 KJ， 0.096 g of protein per mL） at a dose of 250 mL daily for a minimum of 5 d before the operation	Bottled water	30 days postoper-ative	①②⑥ ⑦
GILLIS， 2016^［16］	Adults， elective surgery for colon or rectal neoplasm	22/21	A whey protein supplement was provided in a quantity that matched the patient′s need according to the estimated deficit in dietary protein intake for approximately 4 weeks leading up to the surgery	Placebo	4 weeks postoper-ative	③⑥
GILLIS， 2014^［17］	Adults， elective surgery for colon or rectal neoplasm	38/39	A 4-week trimodal prehabilitation program at home included exercise intervention， nutrition intervention， and coping strategies to reduce anxiety	Standard care	8 weeks postoper-ative	①③④ ⑥
FUJITANI， 2012^［18］	≤80 years， elective total gastrectomy， body weight loss of 10 percent or less within 6 months before entry	127/117	Preoperative oral supplementation of 1 000 mL/d in the form of an immunonutrient-enriched enteral feed added to normal diet for 5 d consecutively before the surgery	Normal diet	Before discharge	①②⑥
BURDEN， 2011^［19］	Adults， elective surgery for colon or rectal neoplasm	54/62	Oral supplementary drink of 400 mL daily， and dietary advice for 10 d before the operation	Dietary advice only	Before discharge	①②⑥
SMEDLEY， 2004^［20］	Adults， elective moderate to severe lower gastrointestinal surgery	48/50	Oral nutritional supplement in small， frequent quantities between meals for 7 d before the operation， the volume consumed was recorded	Normal diet	Before discharge	①②⑥ ⑦
GIANOTTI， 2002^［21］	Adults， major elective surgery for malignancy of the gastrointestinal tract	102/102	Oral nutritional supplement （1 000 mL/d） of a formula enriched with arginine， ω-3 fatty acids， and RNA for 5 d before the operation	Standard care	30 d after discharge	①②⑤ ⑥
BRAGA， 2002^［22］	Adults， elective surgery for gastroin-testinal neoplasm， body weight loss of 10% or more within 6 months before entry	50/50	Oral nutritional supplement （1 000 mL/d） added to normal diet for 7 d consecutively before the surgery	Normal diet	30 d after discharge	①②⑤ ⑥
KABATA， 2015^［23］	Adults， elective， radical gastroin-testinal and abdominal cancer surgery	54/48	Oral nutritional supplement （400 mL/d） added to normal diet for 14 d consecutively before the surgery	Normal diet	30 d postoper-ative	①⑤⑥
BARKER， 2013^［24］	Adults， elective upper and lower gastrointestinal surgery	46/49	Three packs of 237 mL of oral nutritional supplement per day for 5 d before the surgery	Standard care	30 d postoper-ative	①②⑤ ⑥
BERKEL， 2022^［25］	≥60 years， elective surgery for colon or rectal neoplasm	28/29	A personalized 3-week （3 sessions per week， 9 sessions in total） supervised exercise program	Standard care	90 d postoper-ative	①②⑥
HUANG， 2014^［26］	Adults， elective， radical gastroin-testinal， cancer surgery	41/41	Oral nutritional supplement （25 mL/kg） for 7 d before the surgery	Normal diet	Before discharge	①②⑥

Study	Population	Sample size （I/C）	Intervention method	Control method	Follow-up	Outcome
LÓPEZ-RODRÍGUEZ-ARIAS， 2021^［11］	Adults， elective surgery for colon or rectal neoplasm	10/10	A 30-d trimodal prehabilitation program with recommendations on physical exercise， nutritional supplementation， and relaxation exercises to be performed at home before surgery and the first 30 d after hospital discharge	Standard care	12 weeks postoper-ative	①②⑥
BARBERAN-GARCIA， 2018^［12］	Adults， elective major abdominal surgery with high risk	62/63	A personalized prehabilitation program based on their health conditions and social circumstances which encompassed 3 major steps： motivational interview to assess the patients′ adherence profile and to codesign the characteristics of the physical activity program with the patient； personalized program to promote daily physical activity； supervised high-intensity endurance exercise training program	Standard care	Before discharge	①②③ ④⑤⑥
BOUSQUET-DION， 2018^［13］	Adults， elective surgery for colon or rectal neoplasm	37/26	A 4-week multi-modal home-based exercise program with once-weekly supervision consisted of exercise intervention， nutritional intervention and anxiety-reduction strategies	Standard care	8 weeks postoper-ative	①②③ ④⑥⑦
OMMUNDSEN， 2018^［14］	>65 years， elective colorectal cancer surgery and fulfilling predefined criteria for frailty	53/63	A 3-week pragmatic tailored intervention based on the results of the geriatric assessment	Standard care	3 months postoper-ative	①②⑤ ⑥
BURDEN， 2017^［15］	Adults， elective colorectal cancer surgery with preoperative weight loss>1 kg per 3‒6 months	55/45	Oral supplementation （10.1 KJ， 0.096 g of protein per mL） at a dose of 250 mL daily for a minimum of 5 d before the operation	Bottled water	30 days postoper-ative	①②⑥ ⑦
GILLIS， 2016^［16］	Adults， elective surgery for colon or rectal neoplasm	22/21	A whey protein supplement was provided in a quantity that matched the patient′s need according to the estimated deficit in dietary protein intake for approximately 4 weeks leading up to the surgery	Placebo	4 weeks postoper-ative	③⑥
GILLIS， 2014^［17］	Adults， elective surgery for colon or rectal neoplasm	38/39	A 4-week trimodal prehabilitation program at home included exercise intervention， nutrition intervention， and coping strategies to reduce anxiety	Standard care	8 weeks postoper-ative	①③④ ⑥
FUJITANI， 2012^［18］	≤80 years， elective total gastrectomy， body weight loss of 10 percent or less within 6 months before entry	127/117	Preoperative oral supplementation of 1 000 mL/d in the form of an immunonutrient-enriched enteral feed added to normal diet for 5 d consecutively before the surgery	Normal diet	Before discharge	①②⑥
BURDEN， 2011^［19］	Adults， elective surgery for colon or rectal neoplasm	54/62	Oral supplementary drink of 400 mL daily， and dietary advice for 10 d before the operation	Dietary advice only	Before discharge	①②⑥
SMEDLEY， 2004^［20］	Adults， elective moderate to severe lower gastrointestinal surgery	48/50	Oral nutritional supplement in small， frequent quantities between meals for 7 d before the operation， the volume consumed was recorded	Normal diet	Before discharge	①②⑥ ⑦
GIANOTTI， 2002^［21］	Adults， major elective surgery for malignancy of the gastrointestinal tract	102/102	Oral nutritional supplement （1 000 mL/d） of a formula enriched with arginine， ω-3 fatty acids， and RNA for 5 d before the operation	Standard care	30 d after discharge	①②⑤ ⑥
BRAGA， 2002^［22］	Adults， elective surgery for gastroin-testinal neoplasm， body weight loss of 10% or more within 6 months before entry	50/50	Oral nutritional supplement （1 000 mL/d） added to normal diet for 7 d consecutively before the surgery	Normal diet	30 d after discharge	①②⑤ ⑥
KABATA， 2015^［23］	Adults， elective， radical gastroin-testinal and abdominal cancer surgery	54/48	Oral nutritional supplement （400 mL/d） added to normal diet for 14 d consecutively before the surgery	Normal diet	30 d postoper-ative	①⑤⑥
BARKER， 2013^［24］	Adults， elective upper and lower gastrointestinal surgery	46/49	Three packs of 237 mL of oral nutritional supplement per day for 5 d before the surgery	Standard care	30 d postoper-ative	①②⑤ ⑥
BERKEL， 2022^［25］	≥60 years， elective surgery for colon or rectal neoplasm	28/29	A personalized 3-week （3 sessions per week， 9 sessions in total） supervised exercise program	Standard care	90 d postoper-ative	①②⑥
HUANG， 2014^［26］	Adults， elective， radical gastroin-testinal， cancer surgery	41/41	Oral nutritional supplement （25 mL/kg） for 7 d before the surgery	Normal diet	Before discharge	①②⑥

[1]	YANG Ling, HOU Lili, ZHAO Yan, CHEN Weihong, ZHANG Jinfeng, MAO Yan. A meta-analysis of prevalence of mouth opening restriction in patients with oral cancer [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(1): 61-69.
[2]	CHEN Weihong, HOU Lili, YANG Ling, MAO Yan, ZHANG Jinfeng. Efficacy of preventive intervention of cryotherapy on radiation-induced oral mucositis in head and neck cancer: a meta-analysis [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(5): 635-645.
[3]	Yingchao TAN, Junyue YANG, Lina WANG. Association between interleukin-1B-511C/T gene polymorphism and coronary atherosclerotic heart disease: a meta-analysis [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2022, 42(2): 197-204.
[4]	Dewei QIAN, Ren ZHOU, Lichun GUAN, Hang ZHANG, Min YU. Meta-analysis of impacts of inhaled nitric oxide on postoperative renal injury and hemorrhage [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2022, 42(1): 95-100.
[5]	Yi WANG, Cheng CHENG, Hong-yan SHEN, Hong-yan GAO, Yue-ning DAI, Zheng-hui YI. Meta-analysis of efficacy of transcranial magnetic stimulation for the treatment of cognitive function and behavioral and psychological symptoms of dementia in patients with Alzheimer′s disease [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(7): 931-941.
[6]	Lu-hong LI, Yan LUO. Impact of intraoperative continuous pumping of remifentanil on postoperative analgesia after gastrointestinal surgery [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(4): 509-513.
[7]	Jie LIU, Xin-min XIE, Xue-mei ZHI, Jing-yi LU. Meta-analysis of the relationship between sleep duration and the risk of diabetic retinopathy [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(11): 1502-1508.
[8]	Zhi-ling CHEN, Chen LUO, Kang-jia ZHAO, Ling SHEN, San-lian HU. Application of two kinds of analgesia after colorectal cancer surgery: a meta-analysis [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(10): 1344-1350.
[9]	PAN Sheng-ke, LI Hui, WEI Yan-yan, YAO Pei-fen, LI Hua-fang. Placebo effect in primary insomnia: a meta-analysis [J]. , 2020, 40(4): 505-.
[10]	HUANG Yan, ZHANG Xian-gao, LIN Heng, CHENG Shu-ying. Meta-analysis of effect and safety of repetitive transcranial magnetic stimulation on patients with schizophrenia [J]. , 2020, 40(1): 81-.
[11]	WANG Ye-wei, CHEN Yan, FANG Xin-yu, ZHANG Yi, CAI Jun, SONG Li-sheng, ZHANG Chen. Association of serum olanzapine concentration and cytochrome P450 1A2 gene polymorphisms: a meta-analysis [J]. , 2019, 39(10): 1167-.
[12]	MAO Yi-ming, WEI Chang-jiang, WU Chang-jiang, QIN Yuan, LU Jia-hao, LU Wen-qiang. Comparison of efficacy of video-assisted thoracic surgery and conventional lung volume reduction surgery for the treatment of patients with severe chronic obstructive pulmonary disease: a meta-analysis [J]. , 2017, 37(7): 997-.
[13]	CHU Jing-jing, YE Chao, JIN Wen, YIN Xi . Robotic-assisted versus laparoscopic radical prostatectomy: a meta-analysis [J]. , 2017, 37(1): 64-.
[14]	HUANG Xia, SONG Yan-yan. Correlation between smoking and incidence of Alzheimer's disease ——a systematic analysis of case-control studies and prevalence studies [J]. , 2015, 35(6): 870-.
[15]	CHEN Ping-ping, YANG Chen-min. Correlation between polymorphisms of DNA repair gene XRCC3 and ovarian cancer: a meta-analysis [J]. , 2015, 35(5): 718-.