Systematic Early Urinary Catheter Removal Integrated in the Full Enhanced Recovery After Surgery (ERAS) Protocol After Laparoscopic Mid to Lower Rectal Cancer Excision: A Feasibility Study

Abstract

Purpose: Enhanced Recovery After Surgery (ERAS) programs advocate early urinary catheter removal after rectal cancer surgery; however, the optimal duration remains unclear. This study assessed the feasibility of the early urinary catheter removal protocol after rectal cancer surgery within an ERAS pathway and identified predictive factors for failure of this strategy.Methods: Between March 2017 and October 2018, all unselected and consecutive patients who underwent rectal cancer resection and benefited from our ERAS program were included. Urinary complications (infection and retention) were prospectively recorded. Success was defined as catheter removal on postoperative day (POD) 3 without urinary complications.Results: Of 135 patients (male, 63.7%; neoadjuvant chemoradiation, 57.0%; urology history, 17.8%), 120 had early urinary catheter removal with no complications (success rate, 88.9%), 8 did not have urinary catheter removal on POD 3 due to clinical judgment or prescription error, 5 experienced a urinary tract infection, and 2 had acute urinary retention. Obesity (odds ratio [OR], 0.16; P = 0.003), American Society of Anesthesiologists physical status classification > II (OR, 0.28; P = 0.048), antiaggregant platelet medication (OR, 0.12; P < 0.001), absence of anastomosis (OR, 0.1; P = 0.003), and prolonged operative time (OR, 0.21; P = 0.020) were predictive factors for failure. Conversely, optimal compliance with the ERAS program (OR, 7.68; P < 0.001), postoperative nonsteroidal anti-inflammatory drug use (OR, 21.71; P < 0.001), and balanced intravenous fluid therapy (OR, 7.87; P = 0.001) were associated with increased strategy success.Conclusion: Withdrawal of the urinary catheter on POD 3 was successfully achieved after laparoscopic rectal resection and can be safely implemented in the ERAS program.

Safety and efficacy of an enhanced recovery after surgery protocol for elderly patients undergoing colorectal surgery

“…Early removal may be effective in reducing patient discomfort and facilitating early mobilization and prevention of urinary tract infection, but the risk of urinary retention is high. Others have suggested that the appropriate time to remove a urinary catheter is within 72 hours after surgery for rectal cancer [31][32][33]. We routinely attempted to remove the urinary catheter on POD3, but reinsertion was sometimes necessary because of urinary retention, depending on the patient's urological comorbidity or whether pelvic lateral lymph node dissection was performed.…”

Sex Disparities in Rectal Cancer Surgery: An In-Depth Analysis of Surgical Approaches and Outcomes

“…Recently, enhanced recovery after surgery (ERAS) program has shown that early rehab and early feeding in postoperative patients are good prognostic factors for patients' recovery [ 110 111 112 113 114 115 ]. The ERAS program recommends catheter removal on postoperative day 1, but surgeons should be taken care when removing it due to the risk of nerve damage during rectal cancer surgery.…”

“…So, in addition to the ERAS program, the appropriate timing of catheterization should also be considered in patients with rectal cancer [ 116 117 118 ]. One study showed that the appropriate time for catheter removal was 3 days of postoperative day [ 111 ].…”

The Latest Results and Future Directions of Research for Enhanced Recovery after Surgery in the Field of Colorectal Surgery

“…Regarding the timing of postoperative urinary catheter removal, the ERAS Society guidelines recommend 1-3 days after elective colorectal surgery, while the ASCRS guidelines recommend catheter removal within 24 hours for colon-upper rectal resection and within 24-48 hours after mid-lower rectal surgery. Meillat et al [26] reported the outcomes of Foley catheter removal on the third postoperative day in 135 patients who underwent surgery under the ERAS protocol, in accordance with the ERAS Society recommendation. This study found successful removal in 88.9% of cases, with risk factors for failure including obesity, an American Society of Anesthesiologists grade greater than II, anti-aggregation platelet medication, absence of anastomosis, and extended operation time.…”