Clinical effectiveness of enhanced recovery after surgery in robotic prostatectomy: a meta-analysis of systematic review.

Enhanced Recovery After Surgery (ERAS) bundles coordinate multimodal perioperative care to optimize outcomes. Although widely used in radical cystectomy, their role in robot-assisted radical prostatectomy (RARP) is less well defined. In line with PRISMA, literature database were searched for studies comparing ERAS or modified ERAS pathways with conventional care in RARP. Using RevMan, random-effects models generated pooled estimates, reported as weighted mean differences (WMDs), odds ratios (ORs), and 95% confidence intervals (CIs). Seven studies comprising 848 patients (439 ERAS; 409 standard care) met inclusion criteria. ERAS reduced hospital length of stay by 1.02 days (95% CI 0.29-1.74; P = 0.006) and accelerated gastrointestinal recovery, including earlier ambulation (WMD 0.68 days; 95% CI 0.11-1.26; P = 0.02). Time to first flatus and defecation was also shorter (flatus: WMD 1 day; 95% CI 0.65-1.35; P < 0.001; defecation: WMD 0.29 days; 95% CI 0.16-0.42; P < 0.001). No significant differences were observed for complication rates. ERAS protocols in RARP promote faster recovery, particularly gastrointestinal function, without increasing complications. However, as early discharge is now standard in many centers, their added value may be limited. Future studies should determine which ERAS components provide the greatest benefit, especially in high-risk patients requiring structured perioperative care.