Impact of enhanced recovery after surgery or fast track surgery pathways in minimally invasive radical prostatectomy: a systematic review and meta-analysis

Zhengtong Lv, Yi Cai, Huichuan Jiang, Changzhao Yang, Congyi Tang, Haozhe Xu, Zhi Li, Benyi Fan, Yuan Li, Zhengtong Lv, Yi Cai, Huichuan Jiang, Changzhao Yang, Congyi Tang, Haozhe Xu, Zhi Li, Benyi Fan, Yuan Li

Abstract

Background: The enhanced recovery after surgery (ERAS) and fast track surgery (FTS) protocols have been applied to a variety of surgeries and have been proven to reduce complications, accelerate rehabilitation, and reduce medical costs. However, the effectiveness of these protocols in minimally invasive radical prostatectomy (miRP) is still unclear. Thus, this study aimed to evaluate the impact of ERAS and FTS protocols in miRP.

Methods: We searched PubMed, Cochrane Library, Embase, and Web of Science databases to collect randomized and observational studies comparing ERAS/FTS versus conventional care in miRP up to July 1, 2019. After screening for inclusion, data extraction, and quality assessment by two independent reviewers, the meta-analysis was performed with the RevMan 5.3 and STATA 15.1 software. Results were expressed as risk ratio (RR) and weighted mean difference (WMD) with 95% confidence intervals (CIs).

Results: In total, 11 studies involving 1,207 patients were included. Pooled data showed that ERAS/FTS was associated with a significant reduction in length of stay (LOS) (WMD: -2.41 days, 95% CI: -4.00 to -0.82 days, P=0.003), time to first anus exhaust (WMD: -0.74 days, 95% CI: -1.14 to -0.34 days, P=0.0003), and lower incidence of postoperative complications (RR: 0.70, 95% CI: 0.53 to 0.92, P=0.01). No significant differences were found between groups for operation time, estimated blood loss, postoperative pain, blood transfusion rate, and readmission rate (P>0.01).

Conclusions: Our meta-analysis suggests that the ERAS/FTS protocol is safe and effective in miRP. However, more extensive, long-term, prospective, multicenter follow-up studies, and randomized controlled trials (RCTs) are required to validate our findings.

Keywords: Enhanced recovery after surgery (ERAS); fast track; meta-analysis; prostate cancer; radical prostatectomy (RP).

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tau-19-884). The authors have no conflicts of interest to declare.

2020 Translational Andrology and Urology. All rights reserved.

Figures

Figure 1
Figure 1
Preferred reporting items for systematic reviews and meta-analyses flow diagram.
Figure 2
Figure 2
Forest plot evaluating the outcomes of (A) LOS, (B) operation time, (C) estimated blood loss, and (D) complications between ERAS/FTS and conventional care. The size of squares corresponds to the weight of the study in the meta-analysis. The diamond plot represents the overall results of the included trials. The horizontal lines represent the 95% CI. LOS, length of stay; ERAS, enhanced recovery after surgery; FTS, fast track surgery; 95% CI, 95% confidence interval; df, degrees of freedom; IV, inverse variance test; M-H, Mantel-Haenszel test.
Figure 3
Figure 3
Sensitivity analysis of (A) LOS, (B) operation time, (C) estimated blood loss, and (D) complications. The 3 vertical lines represent the overall effect value and its 95%CI. Each circle and horizontal line represent the effect value and 95% CI after removing each indicated study. LOS, length of stay; 95% CI, 95% confidence interval.
Figure 4
Figure 4
The funnel plots of (A) LOS, (B) operation time, (C) estimated blood loss, and (D) complications. The funnel plots seem symmetric, and Egger’s test is non-significant, which suggests that there was no publication bias. LOS, length of stay.
Figure 5
Figure 5
Forest plot evaluating the outcomes of (A) time to first anus exhaust, (B) postoperative pain score, (C) blood transfusion rate, and (D) readmission rate between ERAS/FTS and conventional care. The size of squares corresponds to the weight of the study in the meta-analysis. The diamond plot represents the overall results of the included trials. The horizontal lines represent the 95% CI. ERAS, enhanced recovery after surgery; FTS, fast track surgery; 95% CI, 95% confidence interval; df, degrees of freedom; IV, inverse variance test; M-H, Mantel-Haenszel test.

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Source: PubMed

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