Early removal of nasogastric tube is beneficial for patients undergoing radical cystectomy with urinary diversion

Abstract

Purpose: Examine the beneficial effect of early nasogastric tube (NGT) removal in patients undergoing radical cystectomy with urinary diversion. Patients and Methods: 43 consecutive patients underwent radical cystectomy with urinary diversion and were randomized into 2 groups. In the intervention group (n = 22), the NGT was removed 12 hours after the operation. Comparatively, in the control group (n = 21), the NGT remained in place until the appearance of the first flatus. The appearance of ileus, patient ambulation, time to regular diet, and hospital discharge of the two patient groups were assessed. Patient discomfort due to the NGT was also recorded. Results: The 2 groups showed statistical homogeneity of their baseline characteristics. Two patients (9.09%) from the intervention and 3 patients (14.3%) from the control group developed postoperative ileus and were treated conservatively. No significant differences in intraoperative, postoperative, bowel outcomes or other complications were found between the two groups. All patients preferred the NGT to be removed first in comparison to their other co-existing drains. Conclusions: This is the first randomized, prospective study, to our knowledge, to assess early NGT removal after radical cystectomy. We advocate early removal, independently of the selected type of urinary diversion, since it is not correlated with ileus and is advantageous in terms of patient comfort and earlier ambulation.

Recommendations for the improvement of bladder cancer quality of care in Canada: A consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA), December 2015

“…238 In this study, early removal (12 hours after the operation) was not correlated with ileus and was associated with improved patient comfort and earlier ambulation compared to standard removal of the tube after first flatus. The recommendation is also supported by a meta-analysis of patients undergoing major abdominal surgery, in which postoperative nasogastric intubation was associated with more postoperative complications and no benefits.…”

The impact of oral nutrition in patients after radical cystectomy: an overview

“…No significant differences were identified between cohort and control group in regards to first canalization (4 versus 5 days, p = 0·16) (Cerruto et al ., ). Advantages in comfort can be observed, because patients prefer in the 100% of cases NGT removal (Adamakis et al ., ; Cerruto et al ., ).…”

“…The late return of bowel function is considered the first obstacle to the discharge of patients after RC with urinary diversion (Donat et al, 1999). This is, then, the most common cause of prolonged hospital stay with the following correlated increments in costs (Adamakis et al, 2011). Considering the importance of POI development as a post-operative complication and its consequences such as the increase in hospital stay, costs and late recovery of oral nutrition, studies analysing the NGT use to understand if it decreases the incidence of POI, have been analysed (Inman et al, 2003;Park et al, 2005;De Vries et al, 2012).…”

Enhanced recovery after urologic surgery—Current applications and future directions

“…Maintenance of NGT following cystectomy does not prevent ileus or other complication yet contributes to patient discomfort. [29][30][31] Therefore, early NG tube removal or avoidance of NG placement in association with radical cystectomy should be standard.…”