Enhanced Recovery After Robot-assisted Radical Cystectomy: EAU Robotic Urology Section Scientific Working Group Consensus View

Collins, Justin; Patel, Hiten; Adding, Christofer; Annerstedt, Magnus; Dasgupta, Prokar; Khan, Shamim; Artibani, Walter; Gaston, R.; Piéchaud, Thierry; Catto, James W.F.; Koupparis, Anthony; Rowe, Edward; Perry, Matthew; Issa, Rami; McGrath, John; Kelly, John D.; Schumacher, Martin; Wijburg, Carl; Canda, Abdullah Erdem; Balbay, M.D.; Decaestecker, Karel; Schwentner, Christian; Stenzl, Arnulf; Edeling, Sebastian; Pokupic, Sasa; Stöckle, Michael; Siemer, Stefan; Sánchez-Salas, Rafael; Cathelineau, Xavier; Weston, Robin; Johnson, Mark; D’Hondt, F.; Mottrie, Alexandre; Hosseini, Abolfazl; Wiklund, Peter

doi:10.1016/j.eururo.2016.05.020

Cited by 123 publications

(75 citation statements)

References 78 publications

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“…21 While a specific enhanced recovery after surgery (ERAS) protocol was not recommended, there are a number of important components that should be considered for any patient undergoing radical cystectomy. Overall, utilization of clinical pathways is associated with decreased narcotic usage, lower incidence of postoperative ileus, and shorter hospital length of stay.…”

Section: Treatmentmentioning

confidence: 99%

Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline

et al. 2017

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Purpose This multi-disciplinary, evidence-based guideline for clinically non-metastatic muscle-invasive bladder cancer focuses on the evaluation, treatment, and surveillance of muscle-invasive bladder cancer guided toward curative intent. Materials and Methods A systematic review utilizing research from the Agency for Healthcare Research and Quality (AHRQ) as well as additional supplementation by the authors and consultant methodologists was used to develop the guideline. Evidence-based statements were based on body of evidence strengths Grade A, B, or C and were designated as Strong, Moderate, and Conditional Recommendations with additional statements presented in the form of Clinical Principles or Expert Opinions. (Table 1) Results For the first time, for any type of malignancy, the American Urological Association (AUA), the American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO), and the Society of Urologic Oncology (SUO) have formulated an evidence-based guideline based on a risk-stratified clinical framework for the management of muscle-invasive urothelial bladder cancer. This document is designed to be used in conjunction with the associated treatment algorithm. Conclusions The intensity and scope of care for muscle-invasive bladder cancer should focus on the patient, disease, and treatment response characteristics. This guideline attempts to improve a clinician's ability to evaluate and treat each patient, but higher quality evidence in future trials will be essential to improve level of care for these patients.

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Section: Treatmentmentioning

confidence: 99%

Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline

et al. 2017

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“…Due to improved anaesthesia, better surgical techniques, and centralization of care in high volume centers, reduction in morbidity and mortality has occurred in recent years. Furthermore, the ERAS protocol has also helped to reduce the length of stay and complications [29]. RARC has been suggested to potentially improve the perioperative morbidity.…”

Section: Discussionmentioning

confidence: 99%

Robot assisted radical cystectomy versus open radical cystectomy in bladder cancer (RACE): study protocol of a non-randomized comparative effectiveness study

et al. 2018

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BackgroundDespite the fact that the cost-effectiveness of robot-assisted radical cystectomy (RARC) is not yet proven, and open radical (ORC) cystectomy is recommended as the standard of care in patients with high-risk non-muscle-invasive and muscle-invasive bladder cancer, the use of RARC is still increasing. The objective of the current ongoing comparative effectiveness trial therefore is to study the (cost-)effectiveness of RARC compared to ORC, both in terms of objective (complication rates, oncological outcomes) and patient-reported (health-related quality of life) outcome measures.MethodsThis study is designed as a non-randomized, multicentre comparative effectiveness trial.Centres with an annual caseload of > 20 radical cystectomies can include patients after informed consent has been given. Centres that perform RARC must have passed the (initial) learning curve of 40 cases. A total of 338 (2 × 169) patients will be enrolled from 23 participating centres (12 ORC, 10 RARC and 1 LRC). Follow-up visits will be scheduled at 1, 3, 6 and 12 months. During each follow-up visit, clinical data and health-related quality of life questionnaires will be administered. Costs will be studied using a monthly resource usage questionnaire. Impact on complications and quality of life will be calculated as the average difference between the groups with 95% confidence intervals, adjusted for potential baseline differences by means of propensity score matching.DiscussionThis study aims to contribute to the development of evidence-based guidelines regarding the most cost-effective surgical technique for radical cystectomy.Trial registrationNederlands Trial Register/Dutch Trial Registry, trial identifying number: NTR5362. Registered on 14 August 2015. (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5362).

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“…Enormous problems are associated with the ERAS protocol, such as its effect on medical costs or QoL, its uncertain specificity for cystectomy, and the fact that it remains unestablished. At the same time, the Robotic Urology Section's Scientific Working Group in the European Association of Urology recognized the role of enhanced recovery programs and endorses them as standardized perioperative care for patients undergoing RARC [25]. Therefore, although we could not examine the ERAS protocol in this study, evaluating RARC with the ERAS protocol [26] remains a future priority.…”

Section: Discussionmentioning

confidence: 99%

A preliminary oncologic outcome and postoperative complications in patients undergoing robot-assisted radical cystectomy: Initial experience

et al. 2017

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PurposeRobot-assisted radical cystectomy (RARC) was originally intended to replace open radical cystectomy (ORC) as a minimally invasive surgery for patients with invasive bladder cancer. The purpose of this study was to evaluate the advantages of robotic surgery, comparing perioperative and oncologic outcomes between RARC and ORC.Materials and MethodsBetween June 2012 and August 2016, 49 bladder cancer patients were given a radical cystectomy, 21 robotically and 28 by open procedure. We compared the clinical variables between the RARC and ORC groups.ResultsIn the RARC group, the median estimated blood loss (EBL) during cystectomy, total EBL, operative time during cystectomy, and total operative time were 0 mL, 457.5 mL, 199 minutes, and 561 minutes, respectively. EBL during cystectomy (p<0.001), total EBL (p<0.001), and operative time during cystectomy (p=0.003) in the RARC group were significantly lower compared with the ORC group. Time to resumption of a regular diet (p<0.001) and length of stay (p=0.017) were also significantly shorter compared with the ORC group. However, total operative time in the RARC group (median, 561 minutes) was significantly longer compared with the ORC group (median, 492.5 minutes; p=0.015).ConclusionsThis Japanese study presented evidence that RARC yields benefits in terms of BL and time to regular diet, while consuming greater total operative time. RARC may be a minimally invasive surgical alternative to ORC with less EBL and shorter length of stay.

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Enhanced Recovery After Robot-assisted Radical Cystectomy: EAU Robotic Urology Section Scientific Working Group Consensus View

Cited by 123 publications

References 78 publications

Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline

Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline

Robot assisted radical cystectomy versus open radical cystectomy in bladder cancer (RACE): study protocol of a non-randomized comparative effectiveness study

A preliminary oncologic outcome and postoperative complications in patients undergoing robot-assisted radical cystectomy: Initial experience

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