Enhanced recovery after surgery for radical cystectomy with ileal urinary diversion: a multi-institutional, randomized, controlled trial from the Chinese bladder cancer consortium

Lin, Tianxin; Li, Kaiwen; Líu, Hao; Xue, Xue-Yi; Xu, Ning; Yong, Weiben; Chen, Zhiwen; Zhou, Xiaozhou; Qi, Lin; He, Wei; Tong, Shiyu; Jin, Fengyan; Liu, Xudong; Wei, Qiang; Han, Ping; Gou, Xin; He, Weiyang; Zhang, Xu; Yang, Guoqiang; Zhang, Shen; Xu, Tianmin; Xie, Xin; Xue, Wei; Cao, Ming; Yang, Jin; Hu, Jianyun; Fu-bao, Chen; Li, Peijun; Li, Guangyong; Tong, Xu; Tian, Ye; Wang, Wenying; Song, Dae‐Kyu; Shi, Lei; Xiaoming, Yang; Yang, Yang; Shi, Benkang; Zhu, Yao; Liu, Xigao; Xing, Jinchun; Wu, Zhun; Zhang, Kaiyan; Li, Wei; Liang, Chaozhao; Yang, Cheng; Qi, Ji; Xu, Chuanliang; Xu, Weidong; Zhou, Liqun; Cai, Lin; Xu, En; Cai, Wangfeng; Weng, Minggao; Yiming, SU; Zhou, Fangjian; Jiang, Lijuan; Liu, Zhuowei; Chen, Qiuhong; Pan, Tiejun; Liu, Bo; Zhou, Yu; Gao, Xin; Qiu, Jianguang; Song, Jie; Hu, Cheng; Chen, Shan; Zheng, Yiting; Huang, Jian

doi:10.1007/s00345-017-2108-3

Cited by 47 publications

(42 citation statements)

References 25 publications

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“…In our meta-analysis, a shorter time to defecation in comparison to traditional regimes in pooling of all patients could be shown. Still, in the RCT-group only Frees et al [3] could show a significantly shorter time to defecation, whereas the RCT with the larger cohort by Lin et al [7] as well as pooling of the two RCTs showed no significant difference.…”

Section: Discussionmentioning

confidence: 85%

“…Prospective studies on ERAS implementation could show that length of stay (LOS) can be reduced [5][6][7] although few studies found no significant difference [8]. Regarding complications after RC, the majority of prospective studies showed no significant difference for implementation of an EP [5,9] whereas few studies could show a lower complication rate [10].…”

Section: Introductionmentioning

confidence: 99%

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Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

et al. 2020

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Purpose Different enhanced recovery after surgery (ERAS) protocols (EP) for radical cystectomy (RC) have been published. Protocols highly differ in number of included items and specific measures. Materials and methods A systematic review and meta-analysis on EPs in RC were performed using the databases MedLine, Cochrane Library, Web of science, and Google Scholar. The specific ERAS measures of the protocols were extracted, analyzed, and compared. Pooling of available outcome data was performed for length of stay, complications, readmission rate, and time to defecation. Results The search yielded a total of 860 studies of which 25 studies were included in qualitative and 22 in quantitative analysis. Oral bowel preparation (BP) was omitted in 24/25 (96%) EPs, optimized fluid management was administered in 22/25 (88%) EPs and early mobilization (postoperative day 1) in 21/25 (84%). Gum chewing (n = 12, 46%), metoclopramide (n = 11, 44%), and alvimopan (n = 6, 24%) were the most common measures to prevent postoperative ileus. Our meta-analysis revealed a significant benefit in favor of EPs for the outcome parameters length of stay [mean difference (MD) − 3.46 d, 95% confidence interval (CI) − 4.94 to − 1.98, p < 0.01], complications [Odds ratio (OR) = 0.76, 95% CI 0.61-0.94, p = 0.01] and time to defecation (MD − 1.37 d, 95% CI − 2.06 to − 0.69, p < 0.01). Readmission rate did not show a significant difference (OR = 0.73, 95% CI 0.52-1.03, p = 0.07). Conclusion Current EPs focus on omitting oral BP, early mobilization, and optimized fluid management while they differ in methods preventing postoperative ileus. Our meta-analysis revealed a benefit in introducing these protocols into clinical practice.

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

et al. 2020

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“…Two more studies with identical data sets were also excluded. Finally, seven RCTs ( 6 – 12 ) evaluating the recovery effect of radical cystectomy between ERAS protocols and CRAS protocols were included in the analysis ( Figure 1 ). The baseline characteristics of the studies are presented in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

“…In all the RCTs included in our study, age, sex, and operation type of the patients were the indicator types analyzed. Concerning operation type, 538 patients from the seven RCTs (6)(7)(8)(9)(10)(11)(12) underwent open radical cystectomy. Three RCTs (8, 9, and 12) included 81 patients who underwent robot-assisted radical cystectomy.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of the Efficacy and Safety of Enhanced Recovery After Surgery vs. Conventional Recovery After Surgery on Perioperative Outcomes of Radical Cystectomy

et al. 2020

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Background and objective: Radical cystectomy has been characterized as the most difficult operation in urology because of the complex surgical procedures and postoperative complications. Enhanced recovery after surgery (ERAS), which reduces the incidence of perioperative complications, has been widely used in clinical surgery. Herein, we performed a meta-analysis to evaluate the efficacy and safety of ERAS vs. conventional recovery after surgery (CRAS) on perioperative outcomes of radical cystectomy. Methods: We performed a systematic search of randomized controlled trials (RCTs) in the following databases: Medline, Embase, and the Cochrane Controlled Trials Register, based on the PICOS strategy. The reference lists of the retrieved studies were further surveyed for relevant publications. Results: Our search yielded seven RCTs containing 813 patients. The ERAS group was found to have better performance in the following parameters: length of hospital stay [mean difference (MD) = −1.12, 95% confidence interval (CI): −1.80 to −0.45, P = 0.001], time to first flatus (MD = −0.70, 95% CI: −0.98 to 0.41, P < 0.00001), and time to regular diet (MD = −0.12, 95% CI: −1.76 to −0.28, P = 0.007). However, there were no significant differences between the two groups in major complications [odds ratio (OR) = 0.91, 95% CI: 0.63 to 1.34, P = 0.64], readmission (OR = 1.15, 95% CI: 0.65 to 2.01, P = 0.63), ileus (OR = 0.75, 95% CI: 0.44 to 1.28, P = 0.29), wound infection (OR = 0.56, 95% CI: 0.31 to 1.01, P = 0.05), mortality (OR = 0.69, 95% CI: 0.24 to 1.99, P = 0.49), or time to first bowel movement (MD = −0.55, 95% CI: −1.62 to 0.53, P = 0.32). Conclusion: ERAS reduced the length of hospital stay, time to first flatus, and time to regular diet after cystectomy. Compared to CRAS protocols, ERAS protocols do not increase the risk of adverse events.

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“…In patients undergoing colorectal, urologic, gastric and pancreatic surgery substantial patient and healthcare benefits were acquired with the implementation of ERAS protocols by decreasing LOS, complication rate, and lowering hospital costs [19][20][21][22]. ERAS principles have also long been used in women undergoing major gynecologic surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparison of enhanced recovery protocol with conventional care in patients undergoing minor gynecologic surgery

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et al. 2020

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Introduction: Data regarding the role of the enhanced recovery after surgery (ERAS) protocol in improving postoperative outcomes and postoperative compliance in patients undergoing gynecological surgery, in particular, minor laparoscopic and hysteroscopic gynecological procedures, are limited. Aim: To investigate the impact of the ERAS protocol on time to ambulation, length of stay (LOS), readmissions and postoperative complications in patients undergoing minor gynecological surgical procedures. Material and methods: A total of 104 patients undergoing minor laparoscopic and hysteroscopic gynecological procedures were randomized to the ERAS protocol or conventional care. Time to defecation, ambulation, and solid food intake, bleeding and LOS were recorded for each patient. Results: The amount of intravenous fluid administered in the perioperative (p < 0.001) and postoperative period (p < 0.001) was significantly higher in the conventional care group than in the ERAS group. In addition, time to first defecation (p < 0.001), time to eating solid food (p < 0.001), and time to ambulation (p = 0.008) were shorter in the ERAS group compared to the conventional care group. Length of stay was also significantly shorter in the ERAS group than in the conventional care group (p < 0.001). Conclusions: Implementation of ERAS protocols provides shorter LOS, less fluid intake, early return of bowel function and early mobilization without an increase in complication rate in women undergoing minor laparoscopic or hysteroscopic gynecologic surgery.

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Enhanced recovery after surgery for radical cystectomy with ileal urinary diversion: a multi-institutional, randomized, controlled trial from the Chinese bladder cancer consortium

Abstract: ERAS did not increase 30-day complications compared with CRAS after RC. ERAS may be better than CRAS in terms of bowel movement, tolerance of fluid and regular diet, and ambulation.

Cited by 47 publications

References 25 publications

Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

Systematic Review and Meta-Analysis of the Efficacy and Safety of Enhanced Recovery After Surgery vs. Conventional Recovery After Surgery on Perioperative Outcomes of Radical Cystectomy

Comparison of enhanced recovery protocol with conventional care in patients undergoing minor gynecologic surgery

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