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. 2026 Feb 9;25:21. doi: 10.1186/s12938-025-01504-3

Enhanced recovery after surgery in laparoscopic radical gastrectomy for gastric cancer: efficacy, safety, meta-analysis

Han-Mei Hu 1, Hong-Yu Zhou 1, Li-Li Guo 1, Ling-Ling Chen 1, Zheng Shen 1,✉
PMCID: PMC12884609  PMID: 41664176

Abstract

Objective

To systematically evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) involving laparoscopic radical gastrectomy for gastric cancer (GC).

Methods

A systematic literature search was conducted across four English databases (PubMed, the Cochrane Library, EMBASE, Web of Science) and two Chinese databases (China National Knowledge Infrastructure, Wanfang Database). The search period extended from database inception to 31 December 2024. Meta-analysis was performed using RevMan (v.5.3) software.

Results

Thirteen randomised controlled trials (RCTs) involving 1,915 patients (953 in the experimental group, 962 in the control group) were included. Compared with the control group, the experimental group had shorter postoperative hospital stays, fewer complications, less intraoperative blood loss, shorter time to first flatus, first oral food intake and ambulation and lower C-reactive protein levels on days 1, 3 and 5, but a higher readmission rate. No deaths occurred.

Conclusion

Enhanced recovery after surgery significantly enhances recovery and reduces complications in cases of laparoscopic radical gastrectomy, demonstrating both efficacy and safety. Despite a higher readmission rate, it represents a beneficial perioperative strategy worthy of clinical adoption.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12938-025-01504-3.

Keywords: Gastric cancer, Laparoscopic, Enhanced recovery after surgery, Meta- analysis, Efficacy and safety, Laparoscopic radical gastrectomy

Introduction

Gastric cancer (GC) is one of the most common malignant tumours globally [1]. Its characteristics include non-obvious early symptoms, a low early diagnosis rate, young age, rapid development and poor prognosis, resulting in high treatment difficulty and a serious threat to human health [2]. For patients with GC, radical surgical resection is still the most effective treatment [3]. With advances in medical technology, laparoscopic surgery has been further developed and applied globally. Compared with traditional open surgery, ‘minimally invasive’ laparoscopic technology offers advantages such as reduced trauma and stress responses, shorter postoperative recovery time, lower incidence of postoperative complications and improved postoperative quality of life [4, 5].

The concept of enhanced recovery after surgery (ERAS) was first proposed by Danish surgeon, Henrik Kehlet, in 1997 [6]. It involves a series of perioperative measures to enable patients to recover quickly, with the core purpose of accelerating postoperative recovery, shortening hospital stays and reducing medical costs through multidisciplinary collaboration, without compromising treatment effects or patient safety [7]. This requires collaboration among multidisciplinary teams, including surgeons, anaesthesiologists, physiotherapists and nurses, and involves measures such as preoperative nutritional support, reduced preoperative diet restriction, minimally invasive intraoperative techniques, thermal insulation, perioperative fluid balance management, multimodal analgesia and early postoperative eating and ambulation [8]. Although laparoscopic surgery itself promotes faster recovery, the integration of ERAS protocols may further enhance postoperative outcomes by standardising perioperative care, reducing variability and addressing factors beyond surgical access, such as pain management, nutrition and mobilisation [9].

Reducing perioperative stress responses is the core concept of ERAS [10]. Randomised controlled trials (RCTs) [11] have shown that ERAS programmes are safe and feasible for patients undergoing radical gastrectomy for GC, significantly shortening hospital stays, reducing costs, accelerating gastrointestinal function recovery and lowering the risk of postoperative complications. It remains valuable to examine whether the benefits of ERAS, which are well-established in the context of open surgery, are sustained or even amplified in the context of minimally invasive gastrectomy, where physiological stress is already reduced [12].

For GC, however, despite reports on the use of ERAS in laparoscopic radical gastrectomy, its efficacy and safety remain controversial due to limited sample sizes, varying inclusion/exclusion criteria and inconsistent research items, leading to conflicting conclusions. This study systematically searched relevant domestic and foreign literature to evaluate the efficacy and safety of ERAS in laparoscopic radical gastrectomy cases.

Results

Literature search results

A total of 654 relevant literature studies were retrieved. After excluding duplicates and ineligible studies, 13 RCTs [10, 13–24] were included, involving 1915 patients (953 in the experimental group, 962 in the control group). The literature screening flowchart is shown in Fig. 1.

Fig. 1.

Fig. 1

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Literature screening flow chart

Basic features of the included literature and results of the literature quality evaluation

The basic characteristics of the included studies are shown in Table 1. The 13 RCTs were published between 2012 and 2024, with 9 from China, 2 from South Korea, 1 from Japan and 1 from Italy. The average age of patients ranged from 59 to 72.9 years.

Table 1.

Basic characteristics of included studies and literature quality evaluation levels

Author Year Country Sample size Age Gender Outcome
Experimental group Control group Experimental group Control group Male/Female
Abdikarim [13] 2015 China 30 31 63 ± 12 62 ± 11 41/20 ①②③⑤⑥
Cao [14] 2021 China 85 86 70.8 ± 3.4 71.4 ± 3.7 109/62 ①②③④⑤⑦⑧⑨
Liu [15] 2016 China 42 42 69.2 ± 5.1 70.3 ± 5.8 42/42 ①②③④
Chen [10] 2012 China 19 22 59 62.5 20/21 ①②③⑨
Kang [16] 2018 Korea 46 51 56.3 ± 10.4 54.5 ± 12.6 71/26 ①②③④⑤
Kim [17] 2012 Korea 22 22 52.64 ± 11.57 57.45 ± 14.54 28/16 ①②③④⑤⑦⑧⑨
Tian [18] 2022 China 186 184 58.3 ± 10.5 58.6 ± 10.9 253/117 ①②③④⑤⑥⑦⑧⑨
Wang [19] 2019 China 30 30 58.22 ± 4.31 59.26 ± 5.35 48/12 ①②③⑤⑨
Ming [20] 2017 China 73 76 61 63 98/51 ①②③④⑤⑨
Yamada [21] 2012 Japan 91 100 67 65 134/57 ①②④⑤
Li [22] 2024 China 42 38 54.36 ± 1.29 54.45 ± 1.38 45/35 ①②⑤⑥
Li [23] 2016 China 67 60 72.9 ± 6.7 71.8 ± 8.0 96/31 ①②③④⑤⑥⑨
Giovanardi [24] 2020 Italy 220 220 67.14 ± 13.03 67.18 ± 12.62 260/180 ①②④⑤⑦⑧
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① = Post-operative hospital stay; ② = Post-operative complications; ③ = Intraoperative blood loss;④ = Time to first flatus(Intestinal function recovery); ⑤ = Time to first oral food intake; ⑥ = Time to ambulation; ⑦ = Readmissions; ⑧ = Mortality,⑨ = CRP expression level

All 13 RCTs were evaluated using the Cochrane RCT risk assessment tool. Except for studies by Chen [10] and Yamada [21], all others were rated as quality grade A (Table 2).

Table 2.

Results of risk of bias assessment of included studies (Randomized controlled study)

Included literature Random sequence generation Allocation concealment Blinding of participants and personnel Blinding of outcome assessment Incomplete outcome data Selective reporting Other bias Level of evidence
Abdikarim [13] Low Low Low Low Low Low Low A
Cao [14] Low Low Low Low Low Not clear Low A
Liu [15] Low Low Low Low Low Low Low A
Chen [10] Low Low Not clear Low Low Not clear Low B
Kang [16] Low Low Low Low Low Low Low A
Kim [17] Low Low Low Low Low Not clear Low A
Tian [18] Low Low Low Low Low Low Low A
Wang [19] Low Low Low Low Low Low Low A
Ming [20] Low Low Low Low Low Low Low A
Yamada [21] Low Low Not clear Low Low Not clear Low B
Li [22] Low Low Low Low Low Low Low A
Li [23] Low Low Low Low Low Low Low A
Giovanardi [24] Low Low Low Low Low Low Low A
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Results of the meta-analysis

Eight outcome indicators were analysed: postoperative complications, intraoperative blood loss, time to first flatus, time to first oral intake, time to ambulation, readmission rate, mortality and CRP level.

Post-operative hospital stay (days)

All 13 studies reported postoperative hospital stays. There was high heterogeneity (I2 = 91.1%) and, accordingly, a random-effects model was used. The experimental group had a significantly shorter hospital stay (mean difference [MD] = − 1.82, 95% CI: − 2.55, − 1.08, Z score [Z] = 4.82, two-sided P < 0.001) (Fig. 2a). Sensitivity analysis showed that removing Li [23] reduced heterogeneity to 83%, with a significant effect size (OR = − 1.55,95% CI: − 2.15, − 0.96, Z = 5.09, P < 0.001) (Fig. 3a).

Fig. 2.

Fig. 2

Fig. 2

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Forest plot. a for post-operative hospital stays in ERAS vs control group. b Forest plot for post-operative complications in ERAS vs control group. c Forest plot for intraoperative blood loss in ERAS vs control group. d Forest plot for time to first flatus in ERAS vs control group. e Forest plot for time to first oral food intake in ERAS vs control group. f Forest plot for time to ambulation in ERAS vs control group. g Forest plot for readmissions in ERAS vs control group. h Forest plot for CRP in ERAS vs control group

Fig. 3.

Fig. 3

Fig. 3

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Sensitivity analysis. a Sensitivity analysis forest plot of postoperative hospital stay. b Sensitivity analysis forest plot of postoperative hospital stay. c Sensitivity analysis forest plot of time to first oral intake. d Sensitivity analysis forest plot of time to ambulation. e Sensitivity analysis forest plot of C-reactive protein (CRP) level

Post-operative complications

All 13 studies reported post-operative complications with a significant effect size (I2 = 0.0%). As shown in Fig. 2b, a fixed-effect model showed fewer complications in the experimental group (OR = 0.63, 95% CI: 0.48, 0.82, Z = 3.40, P < 0.001).

Intraoperative blood loss

Ten studies reported intraoperative blood loss with no heterogeneity (I2 = 0.0%). As shown in (Fig. 2c), a fixed-effect model showed less blood loss in the experimental group (MD = − 6.62, 95% CI: − 12.08, − 1.16, Z = 2.38, P = 0.02).

Time to first flatus (days)

Nine studies reported time to first flatus with high heterogeneity (I2 = 76.0%). A random-effects model showed a shorter time in the experimental group (MD = − 0.53, 95% CI: − 0.80, − 0.26, Z = 3.89, P < 0.001) (Fig. 2d). Sensitivity analysis showed that removing Yamada [21] reduced heterogeneity to 68%, with a significant effect size (OR = − 0.62, 95% CI: − 0.85, − 0.39, Z = 5.22, P < 0.001) (Fig. 3b).

Time to first oral food intake (days)

Eleven studies reported time to first oral intake with high heterogeneity (I2 = 97.0%). A random-effects model showed a shorter time in the experimental group (MD = − 0.91, 95% CI: − 1.62, − 0.20, Z = 2.52, P = 0.01). Sensitivity analysis showed removing Kim [18] reduced heterogeneity to 86%, with a significant effect size (OR = − 1.32, 95% CI: − 1.70, − 0.93, Z = 6.65, P < 0.001) (Fig. 2e, Fig. 3c).

Time to ambulation (days)

Four studies reported time to ambulation with high heterogeneity (I2 = 81.0%). A random-effects model showed a shorter time in the experimental group (MD = − 1.04, 95% CI: − 1.57, − 0.52, Z = 3.88, P < 0.001). Sensitivity analysis showed that removing Abdikarim [14] reduced heterogeneity to 47%, with a significant effect size (OR = − 1.42, 95% CI: − 1.62, − 1.23, Z = 14.41, P < 0.001) (Figs. 2f, 3d).

Readmission rate

Four studies reported readmission rates with no heterogeneity (I2 = 0.0%). A random effects model showed a higher readmission rate in the experimental group (OR = 1.82, 95% CI: 1.03, 3.23, Z = 2.07, P = 0.04) (Fig. 2g).

Mortality rate

Among the 13 literature studies included, 2 deaths were reported [14, 18], and Cao [14] reported 1 death in the control group; was due to was respiratory failure caused by severe pulmonary infection; the other, reported by Tian [18], resulted from duodenal leakage combined with abdominal infection.

C-reactive protein expression level (mg/L)

Serum CRP levels were measured on postoperative days 1, 3, and 5; therefore, a subgroup analysis was performed for these time points. There was high heterogeneity (I2 = 81.0%) and, accordingly, a random-effects model was used. Inter-group heterogeneity was significant (P = 0.01), indicating that different postoperative time periods were the sources of heterogeneity. The experimental group had lower CRP levels (MD = − 8.30, 95% CI: − 11.62, − 4.97, Z = 4.89, P < 0.001) on days 1, 3 and 5. Sensitivity analysis showed that removing Tian [18] reduced heterogeneity to 66% (Figs. 2h, 3e).

Publication bias

Publication bias analysis for all 9 indicators showed that the funnel plot for intraoperative blood loss was significantly asymmetrical, suggesting publication bias. Conducting an Egger's test confirmed this (P = 0.006 < 0.05). No obvious bias was found for other indicators (Fig. 4).

Fig. 4.

Fig. 4

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Funnel diagram of intraoperative blood loss

Discussion

This study included 13 RCTs with 1915 patients with GC undergoing laparoscopic radical gastrectomy. Compared with traditional care, the ERAS group had shorter postoperative hospital stays, time to first flatus, time to first oral intake and time to ambulation; fewer complications; less intraoperative blood loss; lower CRP levels on days 1, 3 and 5; but a higher readmission rate. No deaths occurred in the experimental group. This meta-analysis confirms that ERAS significantly improves postoperative recovery, with consistent benefits in terms of hospitalisation duration, complications and inflammatory markers.

The significantly shorter postoperative hospital stay in the ERAS group is a consistent finding and a primary goal of enhanced recovery protocols. This reduction is likely multifactorial, resulting from the synergistic effect of improvements in other outcomes, such as faster recovery of gastrointestinal function, reduced complication rates and better pain control enabling early ambulation [25, 26].

The incidence of postoperative complications was lower in the ERAS group. This may be related to the shorter time to oral feeding, ambulation and first flatus. An important aspect is the postoperative multi-modal combined analgesia approach, which advocates for non-steroidal analgesics instead of opioids, thereby reducing nausea and vomiting and having a lower impact on the gastrointestinal tract [27]. We note that conclusions on complications across studies can be inconsistent, potentially due to variations in the types and scopes of complications included.

Although the difference was statistically significant, the mean reduction in blood loss, while clinically relevant, was modest. This outcome may be more influenced by surgical technique and experience than by ERAS protocols per se. However, the standardised perioperative management in ERAS, including precise fluid management, may contribute to optimised surgical conditions and reduced blood loss [27].

The ERAS group demonstrated a significantly shorter time to first flatus, a key indicator of recovered gastrointestinal motility. This can be attributed to several ERAS components, including the avoidance of prolonged preoperative fasting, minimised use of opioid analgesics, restricted intraoperative fluid infusion to prevent bowel oedema and the encouragement of early oral intake and ambulation [28–30].

The shorter time to first oral intake in the ERAS group is a cornerstone of the ERAS protocol. Relevant studies have found that fasting can enhance postoperative insulin resistance and increase blood sugar levels [28], which is not conducive to recovery. Hyperglycaemia impairs wound and anastomotic healing by compromising neutrophil function, increasing infection risk and reducing collagen synthesis [31, 32]. Compared with traditional prohibition, ERAS strategies such as preoperative carbohydrate loading and early postoperative intake of easily digestible nutrients promote gastrointestinal peristalsis and protect intestinal mucosal barrier function [25].

The shorter time to ambulation in the ERAS group may be directly related to better multimodal analgesia, which improves pain control and allows patients to move earlier [25, 33]. Early ambulation, in turn, helps prevent complications and stimulates the recovery of gastrointestinal function.

The higher readmission rate in the ERAS group (OR = 1.82) warrants careful consideration. Potential causes may include earlier discharge before complete recovery (as ERAS protocols typically reduce hospitalisation by 1.8 days), delayed presentation of complications like anastomotic leaks, as well as inadequate post-discharge support systems. This suggests the need for better discharge criteria and follow-up in ERAS programmes [34].

The lower CRP levels in the ERAS group on postoperative days 1, 3 and 5 indicate a reduced systemic inflammatory and stress response. Surgical trauma leads to the release of pro-inflammatory factors, and the comparison shows that ERAS can effectively mitigate this response, thus promoting recovery [34]. The significantly lower CRP levels observed in the ERAS group indicate a markedly attenuated systemic inflammatory response. This anti-inflammatory effect can be attributed to several key mechanisms within the ERAS protocol. First, preoperative carbohydrate loading mitigates fasting-induced insulin resistance and subsequent pro-inflammatory metabolic responses [35]. Second, opioid-sparing multimodal analgesia reduces opioid-induced immune suppression and gut dysmotility, both known to exacerbate inflammation [36]. Third, goal-directed fluid therapy prevents volume overload and tissue oedema, which can potentiate the inflammatory cascade [37]. Conversely, these detrimental factors (prolonged fasting, liberal fluid administration and a heavy reliance on opioids) in the control group likely contributed to their heightened inflammatory state and poorer recovery. The effectiveness of the ERAS model in reducing trauma and stress before and during surgery likely accelerates postoperative recovery.

Notable variations existed in the specific components of both ERAS and conventional care protocols across studies. We addressed this heterogeneity by employing random-effects models for outcomes with I2 > 50% and performing sensitivity analyses, which confirmed the robustness of our primary findings, despite these differences. For example, 6/13 studies omitted preoperative carbohydrate loading, and analgesic regimens ranged from epidural to opioid-sparing approaches. While sensitivity analyses confirmed consistent benefits for core outcomes (e.g. hospital stay reduction, P < 0.001), protocol differences likely contributed to heterogeneity among secondary measures like time to first flatus (I2 = 76%). Despite considerable variation in the attributes of research participants across the included studies (e.g. surgical procedure and age range), the direction of the treatment effect for primary outcomes such as postoperative hospital stay and complications was consistently in favour of the ERAS group. This consistency strengthens the generalisability of our main findings across a broader patient population. Standardising ERAS components in future trials could help to enhance comparability [38].

This study has the following limitations. Implementation bias is present due to different research centres’ levels of rapid rehabilitation surgery implementation and diverse proficiency levels in laparoscopic surgery. Concurrently, the tumour presence status (pathological grade and clinical stage) among the patients included in each study was inconsistent, which may have given rise to a level of bias in the results. Moreover, the predominance of Asian studies among those included (9/13) may have introduced regional bias, as surgical techniques, patient demographics and healthcare systems differ from those in Western regions. These factors may limit the generalisability of our findings. Therefore, large-scale, high-quality multicentre RCTs encompassing diverse geographic regions are urgently needed to validate our results. Furthermore, while our search strategy aimed to be comprehensive, some studies may have been overlooked if they used non-standard terminology or were published in less-indexed journals. Additionally, while the inclusion of 13 studies falls within an acceptable range for a meta-analysis, this relatively small number may have affected the study’s statistical power to detect smaller effect sizes. This limitation was partially mitigated by the consistency of outcomes across studies (e.g. reduced hospital stay and fewer complications in ERAS groups). Furthermore, due to the limitations related to authority and region, we did not conduct a grey literature search, which may have contributed to publication bias. Additionally, among the 9 outcome indicators, 3 (time to ambulation, readmission rate and CRP on day 5) were analysed in ≤ 5 studies with small sample sizes. While funnel plots showed no significant asymmetry, we acknowledge that small-study effects may inflate effect sizes, particularly for subjective measures like ambulation time. Moreover, heterogeneity in ERAS and conventional care protocols across studies may influence outcomes. While random-effects models were used to account for this variation, the lack of standardised protocols should be considered when interpreting the results. Finally, the clinical heterogeneity in patient attributes (e.g. type of gastrectomy, age) and ERAS protocols across studies may influence outcome generalisability, though random-effects models were used to mitigate this. Future updates should prioritise these understudied outcomes.

Conclusion

This meta-analysis demonstrates that the application of ERAS protocols in laparoscopic radical gastrectomy for GC is effective and safe. Doing so significantly accelerates postoperative recovery, as evidenced by a shorter time to first flatus, first oral intake and ambulation. Furthermore, it enhances safety by reducing postoperative complications and intraoperative blood loss, despite being associated with a higher readmission rate, which warrants attention. Therefore, ERAS represents a beneficial perioperative strategy for patients undergoing this procedure.

Methods

Literature search strategy

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance guidelines, we searched four English databases (PubMed, the Cochrane Library, EMBASE, Web of Science) and two Chinese databases (China National Knowledge Infrastructure, Wanfang Database) from their establishment to 31 December 2024. The search strategy combined Medical Subject Headings (MeSH) and textual keywords using the Boolean operator ‘AND’. Search terms included the following: ① ‘enhanced recovery after surgery’ OR ‘ERAS’ OR ‘fast track surgery’ OR ‘FTS’ OR ‘rapid rehabilitation nursing’; ② ‘laparoscopic radical gastrectomy’ OR ‘laparoscopy-assisted gastrectomy’ OR ‘laparoscopic gastrectomy’; ③ ‘influence’ OR ‘efficacy’. Detailed screening protocols are noted in Supplementary File 1.

Inclusion and exclusion criteria

The inclusion criteria were as follows. (1) Study type: RCTs published in English. (2) Participants: the search strategy combined MeSH and textual keywords using the Boolean operator ‘AND’. (3) Interventions: The experimental group received laparoscopic radical gastrectomy with ERAS; the control group received laparoscopic radical gastrectomy with traditional perioperative care. (4) Outcome indicators (at least one of the following): postoperative time to first oral intake, hospital stay, complications, ambulation time, first flatus time, serum C-reactive protein (CRP) level, intraoperative blood loss, readmission rate and mortality.

The exclusion criteria were as follows. (1) A sample size < 20 cases. (2) Preoperative chemoradiotherapy (neoadjuvant therapy). (3) Non-laparoscopic surgery or laparoscopic conversion to open surgery. (4) Duplicate publications. (5) Reviews and case reports. (6) Non-English publications.

Literature screening and data extraction

Two researchers independently screened the literature. Titles and abstracts were initially screened, followed by full-text reviews based on the inclusion/exclusion criteria. Disagreements were resolved by consulting a third researcher. After screening, two researchers independently extracted data, including basic study characteristics (first author, publication year, sample size [experimental/control group], interventions and outcome indicators).

Literature quality evaluation

Two researchers independently assessed the risk of bias using the RCT risk assessment tool from the Cochrane Manual (v.5.1.0) [39], including the following:① random sequence generation; ② allocation concealment; ③ blinding of participants and personnel; ④ blinding of the outcome assessment; ⑤ incomplete outcome data; ⑥ selective reporting; ⑦ other bias. Each item was graded as ‘low risk’, ‘high risk’ or ‘unclear’. Literature quality was classified as A (fully meeting standards), B (partially meeting), or C (not meeting). Disagreements were resolved by a third researcher.

Statistical analysis methods

Meta-analysis was performed using the RevMan version 5.3 (The Cochrane Collaboration, London, UK) and STATA version 16.0 (StataCorp, College Station, TX, USA) software. The odds ratio (OR) was used for dichotomous data and weighted mean difference for continuous data, with 95% confidence intervals (CIs). We anticipated clinical heterogeneity due to variations in patient characteristics (e.g. type of gastrectomy, age restrictions) across studies. To address this, we prioritised the use of random-effects models, which provide a more conservative estimate by accounting for both within-study and between-study variance. Heterogeneity was tested as follows: if I2 < 50% or P > 0.1, a fixed-effect model (Mantel–Haenszel) was used; if I2 > 50% or P ≤ 0.1, a random-effects model (DerSimonian–Laird) was used. Publication bias was analysed via funnel plots and an Egger's test, with a two-sided α = 0.05.

Supplementary Information

12938_2025_1504_MOESM1_ESM.docx (15.8KB, docx)

Additional file 1: Detailed search strategy.

Acknowledgements

Not applicable

Author contributions

HHM and ZHY conceived of the study, and GLL, CLL and SZ participated in its design and data analysis and statistics. All authors helped to draft the manuscript, read and approved the final manuscript.

Funding

Not applicable.

Availability of data and materials

All data generated or analyzed during this study are included in this published article.

Declarations

Ethics approval and consent to participate

An ethics statement is not applicable because this study is based exclusively on published literature.

Consent for publication

Not applicable.

Competing interests

All of the authors had no any personal, financial, commercial, or academic competing interest separately.

Footnotes

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Associated Data

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Supplementary Materials

12938_2025_1504_MOESM1_ESM.docx (15.8KB, docx)

Additional file 1: Detailed search strategy.

Data Availability Statement

All data generated or analyzed during this study are included in this published article.

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