Introduction
Materials and methods
Search protocol
Inclusion criteria
Statistical analysis
Quality assessment
Certainty of evidence
Results
Study selection
Comparison of ERAS protocols
Study | n (ERAS / Non-ERAS) | Type of study | Urinary diversion EP, n (%) NB, Pouch, IC, UC | Robotic surgery EP, n (%) | Preoperative Counseling / Optimization (spec. measures) |
---|---|---|---|---|---|
Altobelli et al. [14] | 207/177 | Retrospective | 71/6/130/0 (34/3/63/0) | 31 (15) | Yes (not specified) |
Baack Kukreja et al. [1] | 79/121 | Prospective (ERAS only) single center non-randomized | 7/1/113/0 (6/4/90/ 0) | 44 (56) | Yes (stoma, tox cessation, comorbidities, nutrition, physical training) |
Brockmann et al. [25] | 152/147 | Prospective (ERAS only) | n.s./n.s./120/n.s (n.s./n.s./79/n.s.) | 56 (37) | No |
Casans-Francés et al. [2] | 41/97 | Retrospective | 11/0/30/0 (27/0/73/ 0) | 0 (0) | Yes (stoma, tox cessation, comorbidities, nutrition) |
Cerruto et al. [26] | 9/13 | Prospective (ERAS only) single center non-randomized | 9/0/0/0 (100/0/0/0) | 0 (0) | Yes (comorbidities, nutrition) |
Collins et al. [5] | 135/86 | Prospective (all) single center non-randomized | 38/0/97/0 (28/0/72/0) | 135 (100) | Yes (stoma, tox cessation, comorbidities, physical activity, social) |
110/484 | Prospective (ERAS only) single center non-randomized | 105/11/53/0 (62/7/31/0) | 0 (0) | Yes (tox cessation, social) | |
Dutton et al. [22] | 165 | Retrospective | 34/0/131/0 21/0/79/0 | 0 (0) | Yes (stoma, comorbidities, nutrition, physical activity, social) |
Frees et al. [3] | 10/13 | Prospective single center randomized controlled | 3/0/7/0 (30/0/70/0) | 0 (0) | Yes (not specified) |
Jensen et al. [17] | 107 | Prospective single center (RCT for factor mobilization) | 12/3/92/0 (12/2/86/0) | 25 (23) | Yes (stoma, comorbidities, nutrition, physical activity) |
Koupparis et al. [15]a | 102 robotic (For MA: open 52/52)a | Prospective single center non-randomized (MA retrospective) | 11/0/91/0 (11/0/89/0) MA: 4/0/48/0 (7/0/93/0) | 102 (100) MA:0 (0)a | Yes (stoma, social) |
Lin et al. [7] | 144/145 | Prospective multicenter randomized controlled | 53/0/91/0 (37/0/63/0) | 7 (5); Laparascopic: 112 (78) | No |
Liu et al. [28] | 84 / 176 | Retrospective | 0/0/84/0 (0/0/100/0) | 0 (0) | No |
71/40 | Prospective (ERAS only) single center non-randomized | 23/27/31/0 (32/38/30/0) | 0 (0) | Yes (comorbidities, nutrition) | |
Mukhtar et al. [11] | 51/26 | Prospective (all) single center non-randomized | 3/0/48/0 (6/0/94/0) | 0 (0) | Yes (nutrition) |
Palumbo et al. [8] | 74/40 | Prospective (all) single center non- randomized | 22/0/24/25 (30/0/33/34) | 0 (0) | No |
Pang et al. [31] | 393/60 | Prospective (all) single center non-randomized | 25/0/368/0 (6/0/94/ 0) | 28 (7) | Yes (stoma, tox cessation, comorbidities, physical activity) |
Patel et al. [24] | 116/143 | Retrospective, comparison surgical vs. multidisc. ERAS | 19/5/92/0 16/4/79/ 0 | 0 (0) | No |
Persson et al. [32] | 31/39 | Prospective (all) single center non-randomized | 5/0/26/0 (17/0/83/0) | 0 (0) | Yes (not specified) |
Rivas et al. [20] | 19/28 | Retrospective | 4/0/15/0 (21/0/79/0) | Laparascopic: 19 (100) | Yes (not specified) |
Saar et al. [8] | 31/31 | Prospective (all) single center non-randomized | 8/0/23/0 (26/0/74/0) | 31 (100) | No |
Semerjian et al. [33] | 56/54 | Prospective (ERAS only) single center non-randomized | 3/0/53/0 (5/0/95/0) | 8 (14) | Yes (not specified) |
Smith et al. [34] | 27/69 | Retrospective | 0/0/27/0 (0/0/100/0) | 0 (0) | Yes (stoma, nutrition) |
Tan et al. [10] | 40/210 | Prospective (all) single center non-randomized | 11/0/39/0 (22/0/78/0) | 40 (100) | Yes (stoma, comorbidities) |
Wei et al. [35] | 91/101 | Retrospective | 3/0/82/6 (3/0/90/7) | 0 (0) | Yes (tox cessation, nutrition) |
Preoperative counseling
Bowel function
Study | Preoperative bowel preparation (BP) | Prevention of ileus | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Oral | i.v | Rectal | ||||||||||
Oral BP | Rectal BP | Carbohydrate loading | No NGT postop | Gum chewing | Mg2+ | Alvimopan | Others | MCP | Neostigmin | Others | enema | |
Altobelli et al. [36] | − | − | − | − | − | − | + | − | − | − | − | − |
Baack Kukreja et al. [1] | − | − | + | + | + | − | + | + | + | ( +) | − | ( +) |
Brockman et al. [25] | − | − | − | + | − | − | + | − | − | − | − | − |
Casans-Francés et al. [2] | − | − | + | + | + | − | − | + (Lactulose) | + | − | − | − |
Cerruto et al. [26] | − | + | + | + | + | − | − | − | + | − | − | ( +) |
Collins et al. [5] | − | − | + | + | + | − | − | − | + | − | − | − |
− | − | + | + | − | + | + | + (Lactulose) | ( +) | + | − | − | |
Dutton et al. [22] | − | − | + | + | − | − | − | − | + | − | − | − |
Frees et al. [3]] | − | − | + | + | + | − | − | − | + | − | − | − |
Jensen et al. [23] | − | + | + | n.s | − | − | − | n.s | − | − | n.s | − |
Koupparis et al. [37]- | − | − | + | + | + | − | − | − | + | − | − | − |
Lin et al. [7] | + (Laxative) | − | − | + | − | − | − | − | − | − | + | ( +) |
Liu et al. [28] | − | − | + | + | + | + | − | − | − | − | − | − |
− | + | − | − | − | − | − | − | − | − | ( +) | − | |
Mukhtar et al. [11] | − | − | + | + | − | − | − | − | − | − | − | − |
Palumbo et al. [6] | − | + | + | + | − | − | − | − | − | − | − | − |
Pang et al. [31] | − | − | + | + | + | − | − | − | − | − | − | ( +) |
Patel et al. [24] | − | − | − | + | − | + | − | − | − | − | − | |
Persson et al. [32] | − | − | + | + | − | − | − | + (Laxative) | − | − | − | − |
Rivas et al. [38] | − | + | − | + | + | − | − | − | + | − | − | − |
Saar et al. [8] | − | + | + | + | − | + | − | − | + | − | − | + |
Semerjian et al. [33] | − | − | + | + | − | − | + | − | − | − | − | − |
Smith et al. [34] | − | − | + | + | + | + | − | − | − | − | + | − |
Tan et al. [10] | − | − | + | + | + | + | − | − | + | − | − | − |
Wei et al. [35] | − | − | − | + | + | − | − | − | − | − | − | − |
Study | No | Anesthesia | Pain management | |||||
---|---|---|---|---|---|---|---|---|
Antibiotic duration | Avoid long acting sedative | Optimized fluid management | Prevention of PONV | Epidural | Regional Infiltration | Non-epidural pain medication | ||
Altobelli et al. [36] | 207 | 24 h | + | + | n.s | + | - | n.s |
Baack Kukreja et al. [1] | 79 | 24 h | n.s | + | n.s | + (open) | + (lap) | NSAI + paracetamol ± weak opioids ± narcotics |
Brockman et al. [25] | 152 | SD | n.s | + | n.s | + | − | n.s |
Casans-Francés et al. [2] | 41 | SD | + | + (Protocol by Feldheiser et al. [39]) | + (Apfel scale) | + | – | NSAI |
Cerruto et al. [26] | 9 | SD | + | + | + | + | + | NSAI |
Collins et al. [5] | 135 | SD | + (spinal) | + | n.s | − | − | NSAI + opioid |
196 | stent removal | + | + | n.s | − | − | NSAI + Paracetamol | |
Dutton et al. [22] | 165 | SD | n.s | + | n.s | − | + (RSC) | NSAI + weak opioid |
Frees et al. [3] | 12 | n.s | n.s | + (Doppler monitoring) | n.s | + | − | NSAI ± opioid |
Jensen et al. [23] | 57 | SD | n.s | n.s | n.s | − | − | NSAI ± opioid |
Koupparis et al. [37]- | 102 | n.s | n.s | + | + | + | − | Paracetamol + opioid |
Lin et al. [7] | 144 | SD | n.s | n.s | n.s | − | − | n.s |
Liu et al. [28] | 84 | SD | + | + | + | + | − | n.s |
Maffezzini et al. [29] | 71 | drain removal | n.s | + | n.s | + | − | n.s |
Mukhtar et al. [11] | 51 | n.s | + | + | + | + | − | non-opioid |
Palumbo et al. [6] | 74 | POD 4 | + | + (Ringer’s acetate solution 1–2 mg/kg/h) | n.s | − | − | Paracetamol + diclofenac ± weak opioid |
Pang et al. [31] | 393 | 24 h (m) 48 h (f) | + | + (< 1L before bladder removal, use of vasopressors) | + | − | + (RSC) | Paracetamol |
Patel et al. [24] | 116 | n.s | n.s | + (minimally invasive volume monitor) | n.s | + | − | Paracetamol |
Persson et al. [32] | 31 | SD | + | + | + | + | − | n.s |
Rivas et al. [38] | 19 | SD | + | + | n.s | + | − | Avoid opioid |
Saar et al. [8] | 31 | SD | - | - | − | − | − | diclofenac + NSAI ± opioids |
Semerjian et al. [33] | 56 | 24 h | + | + (125-200 ml Ringer/h ± bolus depending on losses, phenylephrine) | + | + (open) | + (Robotic: TAP-Block) | Paracetamol + gabapentin + tranSDermal lidocaine ± weak opioid ± opioid |
Smith et al. [34] | 27 | n.s | n.s | + (esophageal doppler) | n.s | − | + (RSC) | n.s |
Tan et al. [10] | 40 | n.s | + (spinal) | + (esophageal doppler) | n.s | − | − | NSAI + Paracetamol ± opioid |
Wei et al. [35] | 91 | n.s | n.s | + (vascular pressure) | n.s | + | + (RSC) | intravenous opioid on demand |