Introduction: No studies have shown whether the enhanced recovery after surgery (ERAS) protocol is superior to the conventional protocol after robot-assisted laparoscopic radical prostatectomy (RALP). We compared intestinal function and perioperative parameters of patients with prostate cancer after the ERAS and conventional protocols to determine the superior protocol for recovery of intestinal function. Material and Methods: A retrospective analysis of 198 consecutive patients who underwent RALP between August 2013 and June 2015 was conducted. Our study design included 2 cohorts. Patients underwent conventional care in one group (n = 123) and the ERAS protocol in the other group (n = 75). The primary outcome was the time to first defecation. Secondary outcomes were perioperative parameters and the complication rate. Results: The ERAS group showed a significantly shorter time to first defecation than did the conventional group (p = 0.006). Multivariate analysis showed that selection of the ERAS protocol was significantly associated with the number of days for first time to defecation. Conclusions: Successful application of an ERAS protocol was applied to our patients who underwent RALP and did not have major complications. The ERAS protocol included enhanced intestinal recovery. The ERAS group showed a significantly shorter time to first defecation than did the conventional group.

Keywords:
Robot-assisted laparoscopic radical prostatectomy, Enhanced recovery after surgery, Fast-track
1.
Kehlet H, Wilmore DW: Multimodal strategies to improve surgical outcome. Am J Surg 2002;183:630-641.
2.
Mahajna A, Krausz M, Rosin D, et al: Bowel preparation is associated with spillage of bowel contents in colorectal surgery. Dis Colon Rectum 2005;48:1626-1631.
3.
Van den Berghe G, Wouters P, Weekers F, et al: Intensive insulin therapy in critically ill patients. N Engl J Med 2001;345:1359-1367.
4.
Abraham-Nordling M, Hjern F, Pollack J, et al: Randomized clinical trial of fluid restriction in colorectal surgery. Br J Surg 2012;99:186-191.
5.
Yuh BE, Ruel NH, Mejia R, Novara G, Wilson TG: Standardized comparison of robot-assisted limited and extended pelvic lymphadenectomy for prostate cancer. BJU Int 2013;112:81-88.
6.
Sugihara T, Yasunaga H, Horiguchi H, et al: Is mechanical bowel preparation in laparoscopic radical prostatectomy beneficial? An analysis of a Japanese national database. BJU Int 2013;112:E76-E81.
7.
Gustafsson UO, Scott MJ, Schwenk W, et al: Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS®) society recommendations. World J Surg 2013;37:259-284.
8.
Gralla O, Haas F, Roigas J, et al: Fast-track surgery in laparoscopic radical prostatectomy: basic principles. World J Urol 2007;25:185-191.
9.
Magheli A, Knoll N, Gralla O, et al: Impact of fast-track postoperative care on intestinal function, pain, and length of hospital stay after laparoscopic radical prostatectomy. J Endourol 2011;25:1143-1147.
10.
Hansen CT, Sorensen M, Moller C, et al: Effect of laxatives on gastrointestinal functional recovery in fast-track hysterectomy: a double-blind, placebo-controlled randomized study. Am J Obstet Gynecol 2007;196:311.e1-e7.
11.
Tang C, Xu Z, Yi X, et al: Fast track surgery vs. conventional management in the perioperative care of retroperitoneal laparoscopic adrenalectomy. Int J Clin Exp Med 2015;8:16207-16214.
12.
Cerruto MA, De Marco V, D'Elia C, et al: Fast track surgery to reduce short-term complications following radical cystectomy and intestinal urinary diversion with Vescica Ileale Padovana neobladder: proposal for a tailored enhanced recovery protocol and preliminary report from a pilot study. Urol Int 2014;92:41-49.
13.
Agnelli G: Prevention of venous thromboembolism in surgical patients. Circulation 2004;110(24 suppl 1):IV4-IV12.
14.
Orberger M, Palisaar J, Roghmann F, et al: Association between the surgical apgar score and perioperative complications after radical prostatectomy. Urol Int 2017;98:61-70.
15.
Pierorazio PM, Mullins JK, Bivalacqua TJ, et al: Trends in immediate perioperative morbidity and delay in discharge after open and minimally invasive radical prostatectomy (RP): a 20-year institutional experience. BJU Int 2013;112:45-53.
16.
Luckey A, Livingston E, Tache Y: Mechanisms and treatment of postoperative ileus. Arch Surg 2003;138:206-214.
17.
Varadhan KK, Lobo DN, Ljungqvist O: Enhanced recovery after surgery: the future of improving surgical care. Crit Care Clin 2010;26:527-547.
18.
Ozdemir AT, Altinova S, Koyuncu H, et al: The incidence of postoperative ileus in patients who underwent robotic assisted radical prostatectomy. Cent European J Urol 2014;67:19-24.
© 2017 S. Karger AG, Basel
2017
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.