Enhanced recovery after surgery protocol does not reduce the length of postoperative hospitalization after robot-assisted radical prostatectomy. Outcomes from the first randomized controlled trial: the (PROSTA-RAAC) study.

[PURPOSE] To provide the first randomized study assessing the impact of an Enhanced Recovery after Surgery (ERAS) program on the outcomes of robot-assisted radical prostatectomy (RARP).

[METHODS] 129 consecutive patients affected by prostate cancer were randomly assigned to standard-of-care (SoC, 61 patients) or ERAS perioperative protocol (68 patients) during hospitalization for RARP. The differences between the SoC and the ERAS groups were based on preoperative fasting, premedication, anesthesia, analgesia, hydration, and nutrition. The primary endpoint of the study was to compare the length of postoperative hospitalization after RARP surgery between the two groups. Secondary endpoints were the time to autonomous mobilization, the rate of postoperative comorbidities, and patients' quality of life (QoL) as assessed by a validated questionnaire. The trial was registered on 21/12/2021 on ClinicalTrials.gov (NCT05172986).

[RESULTS] Time to autonomous mobilization after surgery was significantly shorter in the ERAS group than in the SoC group (11.9 ± 5.7 h for ERAS and 17.2 ± 5.0 h for SoC, p < 0.001). However, there was no statistically significant difference in the length of postoperative hospitalization (43.1 ± 10.4 vs. 43.7 ± 18.1 h for the SoC and ERAS group, respectively, p = 0.81), time to oral nutrition, complication rate within 30 days from surgery, and QoL domains.

[CONCLUSION] Prehabilitation, surgical expertise, and optimized SoC may limit further benefits from ERAS in contemporary RARP. When these three conditions were satisfied, ERAS did not further reduce the length of postoperative hospitalization, time to oral nutrition, postoperative complications, and the impact of surgery on the main domains of the patient's QoL.