Enhanced Recovery After Surgery Improves Perioperative Outcomes After Laparoscopic Radical Prostatectomy:A Meta-analysis

Objective: To perform a systematic review and meta-analysis to evaluate efficacy and safety of enhanced recovery after surgery(ERAS)after radical prostatectomy.Methods: We performed a systematic electronic literature search of PubMed,The Cochrane Library,EMBASE,CNKI,WANFANG database,VIP and Chinese biomedical literature database.All randomized controlled trials(RCTs)exploring the effectiveness of ERAS on improving perioperative outcomes including length of hospital stay,rates of overall complication,the time of first defecation and readmission after mainstream surgery methods of radical prostatectomy were collected.Literature screening,data extraction and quality assessment were independently performed by two reviewers according to the defined eligibility criteria.Meta-analysis was performed using RevMan5.3 software.Result: A total of eight studies,including 1407 patients,met the eligibility criteria,in which 644 and 763 patients were divided into the ERAS and standard care group,respectively.According to the different surgery methods,meta-analysis indicated a significantly shorter length of hospital stay in LRP(Laparoscopic Radical Prostatectomy)(WMD=-3.46,95%CI:-5.27~-1.64,P =0.0002),but no significant difference in RALP(Robot-Assisted Laparoscopic Radical Prostatectomy)(WMD=-1.56,95%CI:-3.87~0.75,P=0.19).According to the different surgery methods,A significantly lower rate of overall complications in LRP(RR=1.16,95%CI:0.23~5.87,P =0.003)and in RALP(RR=0.99,95%CI:0.52~1.90,P =0.01)were demonstrated.Meta-analysis showed a significantly shorter time of first defection in both LRP(WMD=-31.33,95%CI:-65.30~2.65,P<0.0001)and RALP(WMD=-11.78,95%CI:-17.06~-6.51,P<0.0001).However,there were no significant difference between two groups in rates of pneumonia,bowel obstruction,urinary leakage.Conclusions: ERAS protocols are safe and effective for males after laparoscopic radical prostatectomy.It can significantly reduce the length of hospital stay and decrease rate of complications in laparoscopic radical prostatectomy.