Impact of the Enhanced Recovery After Surgery Protocol on the Perioperative Outcomes of Robot-Assisted Radical Cystectomy

<b>Objectives</b>: The enhanced recovery after surgery (ERAS) protocol is a coordinated approach aimed at providing the best evidence-based perioperative care. This study examined whether combining robot-assisted radical cystectomy (RARC) with the ERAS protocol could reduce postoperative complications and hospital length of stay (LOS). We also assessed the impact of high and low adherence to the ERAS protocol on oncological outcomes. <b>Methods</b>: Eighty patients who underwent RARC with urinary diversion at Juntendo University Hospital and Juntendo University Nerima Hospital between April 2014 and December 2021 were included. The ERAS protocol consisted of 15 items, and the achievement rate for each item was assessed. We evaluated the effects of adherence on complications and hospital LOS, as well as the relationship between ERAS implementation and postoperative oncological prognoses. <b>Results</b>: Patients were divided into high-adherence (n = 39) and low-adherence (n = 41) groups based on adherence to 12 or more ERAS items. Patient demographics, including age, sex, and clinical stage, were statistically similar. The high-adherence group had a significantly shorter postoperative hospital LOS (19 days vs. 24 days; <i>p</i> = 0.013) and fewer complications (<i>p</i> = 0.015) compared to the low-adherence group. Furthermore, the high-adherence group exhibited a significantly improved overall survival rate (<i>p</i> = 0.029), while no significant difference was found in progression-free survival (<i>p</i> = 0.125). <b>Conclusions</b>: Integrating the ERAS protocol with RARC can reduce postoperative complications and hospital LOS. High adherence to the ERAS protocol is associated with improved prognoses and outcomes compared to low adherence.