A systematic review and meta-analysis: evaluating the enhanced recovery after surgery protocol for perioperative care in robot-assisted radical cystectomy.

For muscle-invasive bladder cancer, radical cystectomy (RC) with urinary diversion is the primary therapeutic strategy. Robot-assisted RC (RARC) is now widely adopted, offering improved postoperative recovery. However, the utility of the Enhanced Recovery After Surgery (ERAS) pathway in this context remains uncertain. To address this gap and inform clinical practice, a meta-analysis was conducted evaluating the safety and efficacy of ERAS in RARC. Studies comparing RARC with ERAS pathways versus non-ERAS protocols were identified through systematic searches of PubMed, the Cochrane Library, Embase, and Web of Science. Evaluated outcomes included operative time, hospital stay, time to first flatus and defecation, and 30- and 90-day complication rates. Odds ratios (OR) and weighted mean differences (WMD) were used to pool binary and continuous data, respectively. A total of four studies were included, involving 473 eligible patients (251 in the ERAS group and 222 in the non-ERAS group). The ERAS group demonstrated markedly shorter hospital stay (WMD = -3.09 days, 95% CI: -4.17 to -2.00, p < 0.05), and time to first flatus (WMD = -0.3 days, 95% CI: -0.38 to -0.23, p < 0.05) and defecation (WMD = -0.41 days, 95% CI: -0.65 to -0.16, p < 0.05), along with a lower incidence of overall complications at 30 days postoperatively (OR = 0.43, 95% CI: 0.25 to 0.73, p < 0.05) and POI (OR = 0.40, 95% CI: 0.22 to 0.73, p < 0.05). However, no notable difference was observed between the two groups in operative time (WMD = -60.38 min, 95% CI: -131.82 to 11.07, p = 0.1) and the incidence of overall complications at 90 days after surgery (OR = 0.25, 95% CI: 0.06 to 1.09, p = 0.07). Our analysis indicates that ERAS management in RARC yields superior perioperative outcomes, including shorter operative duration, decreased length of stay, faster gastrointestinal recovery, and fewer 30-day complications. However, there were no significant differences between the two groups in terms of the operation time and the 90-day postoperative complication rate. Although ERAS does not alter the disease course, it optimizes the recovery process. It must be acknowledged, however, that these conclusions are exploratory and require corroboration through additional well-designed research.