Lv Zhengtong, Cai Yi, Jiang Huichuan, Yang Changzhao, Tang Congyi, Xu Haozhe, Li Zhi, Fan Benyi, Li Yuan
Department of Urology, Xiangya Hospital, Central South University, Changsha, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
Transl Androl Urol. 2020 Jun;9(3):1037-1052. doi: 10.21037/tau-19-884.
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.
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).
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).
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.
手术加速康复（ERAS）和快速康复外科（FTS）方案已应用于多种手术，并已被证明可减少并发症、加速康复并降低医疗成本。然而，这些方案在微创根治性前列腺切除术（miRP）中的有效性仍不明确。因此，本研究旨在评估ERAS和FTS方案在miRP中的影响。
我们检索了PubMed、Cochrane图书馆、Embase和Web of Science数据库，以收集截至2019年7月1日比较miRP中ERAS/FTS与传统护理的随机和观察性研究。在由两名独立评审员进行纳入筛选、数据提取和质量评估后，使用RevMan 5.3和STATA 15.1软件进行荟萃分析。结果以风险比（RR）和加权平均差（WMD）表示，并带有95%置信区间（CI）。
总共纳入了11项研究，涉及1207例患者。汇总数据显示，ERAS/FTS与住院时间（LOS）显著缩短相关（WMD：-2.41天，95%CI：-4.00至-0.82天，P = 0.003）、首次肛门排气时间（WMD：-0.74天，95%CI：-1.14至-0.34天，P = 0.0003）以及术后并发症发生率较低（RR：0.70，95%CI：0.53至0.92，P = 0.01）。两组在手术时间、估计失血量、术后疼痛、输血率和再入院率方面未发现显著差异（P>0.01）。
我们的荟萃分析表明，ERAS/FTS方案在miRP中是安全有效的。然而，需要更广泛、长期、前瞻性、多中心的随访研究和随机对照试验（RCT）来验证我们的发现。
