Early recovery protocol in patients undergoing laparoscopic radical cystectomy

Abstract

Keywords:ERAS laparoscopic radical cystectomy muscle-invasive bladder cancer a b s t r a c t Introduction: The Enhanced Recovery After Surgery program (ERAS), has become the basis of perioperative management after colorectal surgery, vascular, thoracic, and more recently the radical cystectomy. The aim of this study is to show our initial experience using an ERAS protocol. Materials and methods: A total of 47 laparoscopic radical cystectomies (LRC) were compared in this study. For retrospective data analysis, the patients were divided into two groups: Group A included patients who underwent LRC before the ERAS protocol was implemented; and Group B included patients who underwent LRC after the ERAS protocol was implemented. Results: Hospital stay was significantly shorter (p ¼ 0,04) in Group B with a median of 11.73 days versus 17.53 days in Group A. The paralytic ileus is the most common complication in both groups, and only two complications seem to be lower between groups; central vein catheter infection in Group A was 14.2% versus 5.2% in Group B and paralytic ileus in Group A was 35.7% versus 21.0% in Group B. There was no statistical difference between groups in the appearance of minor or major complications. Conclusion: The combination of minimally invasive surgery and an ERAS protocol is a feasible multidisciplinary challenge and is useful in the recovery of patients undergoing LRC.

Enhanced Recovery After Surgery Protocols in Major Urologic Surgery

“…Studies of laparoscopic RC state different benefits. In the study ( 84 ) of 47 patients undergoing laparoscopic RC, before and after the implementation of the ERAS protocol, ERAS group had lower frequency of central vein catheter infection and paralytic ileus. Guan et al ( 85 ) showed that patients with fast-track laparoscopic RC had shorter time to first flatus and regular diet, lower serum C-reactive protein and white blood count on the fifth and seventh day after surgery, as well as lower frequency of complications.…”

Impacto de un programa de recuperación intensificada en cistectomía radical. Estudio comparativo de cohortes

“…En el grupo histórico 3 fallecimientos fueron por parada cardiorrespiratoria de origen no filiado en el curso de un postoperatorio con complicaciones, 2 ocurrieron en el curso de un cuadro de isquemia aguda de extremidades inferiores, 2 por shock séptico, uno por celulitis necrosante, otro por insuficiencia renal aguda y otro por un síndrome de distrés respiratorio del adulto. En cuanto a la estancia media, se halló una diferencia de medias de 4,064 días a favor del grupo ERAS, pero el análisis de las medianas de los grupos no halló que esta diferencia fuera estadísticamente significativa (mediana [RIC] = 15 [9, vs. 16 [12][13][14][15][16][17][18] días; p = 0,186]. Tampoco se hallaron diferencias en la estancia en la unidad de críticos (mediana [RIC] = 1,21 [1,01-2,09] vs. 1 [1][2][3] días; p = 0,582).…”

“…El análisis de subgrupos «ad hoc» según el tipo de técnica quirúrgica realizada no reveló cambios en los resultados de las variables a comparar, salvo en el tiempo hasta la extubación del grupo al que se le realizó una reconstrucción neovesical ortotópica tipo Studer, en el que no hubo diferencias significativas con el grupo control ( este análisis de subgrupos pueden verse como material suplementario (disponible en la web). El análisis «post hoc» de la estancia hospitalaria según la presencia o no de complicaciones mostró que los pacientes del grupo ERAS que no habían tenido complicaciones presentaban una estancia hospitalaria menor con respecto a los pacientes de la cohorte histórica, tanto en los pacientes que no presentaron complicaciones globales (mediana [RIC] = 9 [8][9][10][11] vs. 13 [11][12][13][14][15][16] días; p = 0,006) como en los pacientes que no habían presentado complicaciones grado Clavien-Dindo > 2 (mediana [RIC] = 10 [9][10][11][12][13][14] vs. 12 [11][12][13][14][15][16] días; p = 0,186). Los resultados de este análisis de subgrupos pueden verse en la tabla 4.…”

Laparoscopic radical cystectomy with pelvic re-peritonealization: the technique and initial clinical outcomes

“…The incidence of paralytic ileus is reportedly significantly reduced by implementing ERAS protocols in patients undergoing radical cystectomy [9, 12]. However, most items addressed in ERAS protocols are pre- or post-operative; there are few reports on improving surgical techniques to reduce the incidence of gastrointestinal complications.…”