Comparative Analysis Of Clinical Efficacy Of Enhanced Recovery After Surgery And Traditional Perioperative Management Mode In Robot-assisted Laparoscopic Prostatectomy

Objective:To investigate the clinical efficacy of enhanced recovery after surgery for prostate cancer patients undergoing robot-assisted laparoscopic prostatectomy compared to traditional perioperative management mode.Methods:The perioperative data of patients who underwent robot-assisted laparoscopic prostatectomy at Nanjing Drum Tower Hospital Affiliated to Nanjing University School of Medicine from October 2017 to August 2018 was retrospectively analyzed.The enhanced recovery after surgery(ERAS)group and the traditional perioperative management mode group contained 70 patients with prostate cancer respectively according to the inclusion and exclusion criteria.Patients’information including age,gender,body mass index(BMI),history of chronic diseases(diabetes,hypertension),preoperative laboratory test results(albumin(Alb)and hemoglobin(Hb)),preoperative Eastern American Oncology Collaboration Group(ECOG)score,preoperative expanded prostate cancer composite index-urinary symptom score scale(EPIC-UA)score,prostate volume,preoperative initial PSA,clinical tumor stage and Gleason score;intraoperative estimated blood loss and blood transfusion ratio,the operation time,the proportion of serious complications(rectal injury,obturator nerve injury,large blood vessel injury),postoperative data(6h pain score,the time interval of the first anal exhaust,the first ambulation,the first eating after returning to the ward,management of postoperative ducts(nasogastric tube,drainage tube),some laboratory test(albumin,hemoglobin)results on the first postoperative day,postoperative complications,major pathological results(pathological stage,surgical margin),length of hospitalization,early continence in the first month after surgery).Subsequently,to study the difference of perioperative data between ERAS group and traditional perioperative management group.Results:Both patients in the ERAS group and the traditional group were successfully performed robot-assisted laparoscopic prostatectomy,and all had been recovered smoothly and discharged,followed by no readmission.1.Preoperative data:No difference was found in age,BMI,ratio of chronic disease(hypertension/diabetes),preoperative laboratory tests such as Alb and Hb,preoperative ECOG score,prostate volume,initial serum total PSA,preoperative EPIC-UA score,clinical tumor stage,and Gleason score between the ERAS group and the traditional group(P>0.05).2.Intraoperative data:There was no significant difference in the operation time,intraoperative estimated blood loss,ratio of complication(rectal injury,obturator nerve injury,large vessel injury)between ERAS group and control group(P>0.05).3.Postoperative data:The 6h postoperative pain score of ERAS group was significantly less than the traditional group(1 score:84%vs 29%,2 score:16%vs 41%,p<0.001).The mean of the first activity time was lower in ERAS group compared to the traditional group(378.1±35.8min vs 651.1±102.8min,p<0.001).There was statistically significant difference between the ERAS group and the traditional perioperative management group in the time of the first exhaust time(1day after operation:ERAS 86%vs conventional 64%;2 day after operation:ERAS 14%vs conventional 36%,p=0.043),the mean length of hospital stay(ERAS group:4.96±1.62d vs 9.01±2.18d,P<0.001).There was no significant difference in the grading of Clavien-Dindo,positive surgical margins,postoperative laboratory tests,and urinary recovery at 1 month after surgery between the ERAS group and conventional group(P>0.05).Conclusion:Using of ERAS strategies was safe and beneficial for prostate cancer patients undergoing RALP,which may effectively relieve the postoperative pain,facilitate the recovery of gastrointestinal function,shorten the length of hospital stay,accelerate patients’ rehabilitation,improve the quality and reduce the urgency on medical resources.