Enhanced recovery after surgery (ERAS) might be a standard care in radical prostatectomy: a systematic review and meta-analysis.

Background: Several enhanced recovery after surgery (ERAS) protocols for radical prostatectomy (RP) have been reported in recent years. Nonetheless, there is no sufficient evidence to support the implementation of ERAS as a standard of care modality.

Methods: A search was done in the PubMed, Embase, Clinical Trials.gov, Cochrane Library, CNKI Library databases and reference lists to identify relevant studies from inception until May 2019 to be included in the study. A systematic review of five randomized controlled trials (RCTs), one prospective cohort study and four retrospective studies covering 3,803 patients, comparing ERAS with conventional care was performed. Outcomes of interest for the study were intraoperative outcomes (operation time and blood loss), postoperative outcomes (hospital stay, catheter stay, first defecation and first anal exhaust) and postoperative complications. Random events meta-analyses were performed. Sensitivity analysis was also performed to determine whether the results of the meta-analysis were robust.

Results: Notably, ERAS group had significantly shorter hospital stay [overall standardized mean difference (SMD) =-1.65, 95% confidence interval (CI): -2.53, -0.76, P<0.001], shorter time to first defecation (overall SMD =-1.56, 95% CI: -2.71, -0.42, P=0.008), shorter time to first anal exhaust (overall SMD =-1.23, 95% CI: -1.97, -0.50, P=0.001) and lower incidence of nausea [overall risk ratio (RR) =0.62, 95% CI: 0.40, 0.94, P=0.024] compared to the conventional group. There was no statistical difference in intraoperative outcomes, catheter stay and other postoperative complications between the two groups (P>0.05).

Conclusions: The data presented so far consistently show that ERAS may be utilized as a standard of care in RP treatment.