Comparison of enhanced recovery after surgery protocol and conventional approach after laparoscopic transperitoneal radical prostatectomy: a retrospective analysis

Abstract

Background Although open radical prostatectomy has been used in the treatment of localized prostate cancer for a long time, minimally invasive surgical approaches such as laparoscopic radical prostatectomy and robot-assisted radical prostatectomy have recently gained importance in order to improve postoperative results and shorten hospital stay. Although the enhanced recovery after surgery (ERAS) protocol was first defined for gastrointestinal surgeries in 2001, it has now been used in gynecological, orthopedic, thoracic and urological surgeries. In our study, we aimed to compare the results of the ERAS protocol with the conventional approach in patients who underwent laparoscopic radical prostatectomy. Methods There is a retrospective analysis of 70 patients who underwent laparoscopic radical prostatectomy at Kayseri City Hospital between May 2018 and January 2021. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) for Windows, version 25.0 (IBM SPSS, Armonk, NY, USA). Seventy patients were included in the study. While 48 patients who underwent perioperative care with the traditional approach were included in the conventional group, 22 patients were included in the ERAS group. Age, comorbidities, preoperative PSA level, digital rectal examination findings, preoperative imaging, extra prostatic spread and lymph node involvement, location of tumors, time between biopsy and surgery, lymphadenectomy status, and histopathological findings of transrectal ultrasound biopsy and prostatectomy specimens were recorded for each patient. Initiation of enteral feeding, time to first defecation, duration of antibiotic use, ileus development rate and length of hospital stay (LOS) were compared for both groups. Results The mean age of 48 patients in the conventional group was 63.37\u2009±\u20097.01\xa0years, while the mean age of 22 patients in the ERAS group was 66.36\u2009±\u20095.31\xa0years ( p \u2009=\u20090.080). Although the first defecation time was shorter in the ERAS group (4.75\u2009±\u20093.21 vs. 3.73\u2009±\u20092.12\xa0days, p \u2009=\u20090.179), there was no statistically significant difference. Ileus developed in 10 (20.8%) patients in the conventional group and 2 (9.1%) in the ERAS group. Use of antibiotics in the postoperative period in the conventional group (5.83\u2009±\u20093.62 vs. 3.18\u2009±\u20092.42\xa0days, p \u2009=\u20090.003) and LOS (7.92\u2009±\u20093.26 vs. 5.91\u2009±\u20092, 15\xa0days, p \u2009=\u20090.011) were statistically significantly longer. Conclusion In summary, ERAS protocol is associated with short LOS, time to initiation of enteral feeding and duration of antibiotics use. There was no statistically significant difference in the rate of ileus and time to first defecation between the two groups. Randomized prospective studies on heterogeneous and larger patient groups are needed to confirm our findings.