AUTHOR=Zhang Dongxu , Sun Kai , Wang Tianqi , Wu Gang , Wang Jipeng , Cui Yuanshan , Wu Jitao 

TITLE=Systematic Review and Meta-Analysis of the Efficacy and Safety of Enhanced Recovery After Surgery vs. Conventional Recovery After Surgery on Perioperative Outcomes of Radical Cystectomy

JOURNAL=Frontiers in Oncology

VOLUME=10

YEAR=2020

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2020.541390

DOI=10.3389/fonc.2020.541390

ISSN=2234-943X

ABSTRACT=<p><bold>Background and objective:</bold> Radical cystectomy has been characterized as the most difficult operation in urology because of the complex surgical procedures and postoperative complications. Enhanced recovery after surgery (ERAS), which reduces the incidence of perioperative complications, has been widely used in clinical surgery. Herein, we performed a meta-analysis to evaluate the efficacy and safety of ERAS vs. conventional recovery after surgery (CRAS) on perioperative outcomes of radical cystectomy.</p><p><bold>Methods:</bold> We performed a systematic search of randomized controlled trials (RCTs) in the following databases: Medline, Embase, and the Cochrane Controlled Trials Register, based on the PICOS strategy. The reference lists of the retrieved studies were further surveyed for relevant publications.</p><p><bold>Results:</bold> Our search yielded seven RCTs containing 813 patients. The ERAS group was found to have better performance in the following parameters: length of hospital stay [mean difference (MD) = −1.12, 95% confidence interval (CI): −1.80 to −0.45, <italic>P</italic> = 0.001], time to first flatus (MD = −0.70, 95% CI: −0.98 to 0.41, <italic>P</italic> &lt; 0.00001), and time to regular diet (MD = −0.12, 95% CI: −1.76 to −0.28, <italic>P</italic> = 0.007). However, there were no significant differences between the two groups in major complications [odds ratio (OR) = 0.91, 95% CI: 0.63 to 1.34, <italic>P</italic> = 0.64], readmission (OR = 1.15, 95% CI: 0.65 to 2.01, <italic>P</italic> = 0.63), ileus (OR = 0.75, 95% CI: 0.44 to 1.28, <italic>P</italic> = 0.29), wound infection (OR = 0.56, 95% CI: 0.31 to 1.01, <italic>P</italic> = 0.05), mortality (OR = 0.69, 95% CI: 0.24 to 1.99, <italic>P</italic> = 0.49), or time to first bowel movement (MD = −0.55, 95% CI: −1.62 to 0.53, <italic>P</italic> = 0.32).</p><p><bold>Conclusion:</bold> ERAS reduced the length of hospital stay, time to first flatus, and time to regular diet after cystectomy. Compared to CRAS protocols, ERAS protocols do not increase the risk of adverse events.</p>