Clinical efficacy of enhanced recovery after surgery (ERAS) program in patients undergoing radical prostatectomy: a systematic review and meta-analysis

BACKGROUND: Enhanced recovery after surgery (ERAS) protocol has been identified to be beneficial in the amount of operations such as gastrointestinal surgery. However, the efficacy and safety in robot-assisted laparoscopic prostatectomy/laparoscopic radical prostatectomy (RALP/LRP) still remain controversial. METHOD: We searched randomized controlled trials and retrospective cohort studies comparing ERAS versus conventional care for prostate cancer patients who have undergone RALP/LRP. ERAS-related data were extracted, and quality of included studies was assessed using the Newcastle-Ottawa quality assessment scale and the Jadad scale. RESULT: As a result, seven trials containing 784 prostate cancer patients were included. ERAS was observed to be significantly associated with shorter length of hospital stay (SMD − 2.55, 95%CI − 3.32 to − 1.78, P < 0.05), shorter time to flatus (SMD − 1.55, 95%CI − 2.26 to − 0.84, P < 0.05), shorter time to ambulate (SMD − 6.50, 95%CI − 10.91 to − 2.09, P < 0.05), shorter time to defecate (SMD − 2.80, 95%CI − 4.56 to − 1.04, P < 0.05), and shorter time to remove drainage tube (SMD − 2.72, 95%CI − 5.31 to − 0.12, P < 0.05). Otherwise, no significant difference was reported in other measurements. CONCLUSIONS: In conclusion, ERAS can reduce length of hospital stay, time to flatus, time to defecate, time to ambulate, and time to remove drainage tube in prostate cancer patients who have undergone RALP/LRP compared with conventional care.