Enhanced recovery after surgery (ERAS) following radical cystectomy: is it worth implementing for all patients?

Hanna, Peter; Zabell, Joseph; Osman, Yasser; Hussein, Mohamed; Mostafa, Magdy Mahmoud; Weight, Christopher J.; Konety, Badrinath R.

doi:10.1007/s00345-020-03435-1

Cited by 23 publications

(17 citation statements)

References 27 publications

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“… 35 In a postoperative setting, the enhanced multidisciplinary care pathways like ERAS (Enhanced Recovery After Surgery) and NEEW (Nutrition, Exercise, Education and Wellness) were also reported to improve early outcomes. 36 , 37 In line with previous reports, our study found that RC in the elderly population is feasible and may be accomplished without incurring an excessive risk of severe complications, compared to younger patients. 19 Moreover, 90-day mortality rates observed in our study (4.47% and 7.27% for younger and older patients respectively) remain consistent with data from the literature.…”

Section: Discussionsupporting

confidence: 89%

Increased One-Year Mortality Among Elderly Patients After Radical Cystectomy for Muscle-Invasive Bladder Cancer: A Retrospective, Observational Comparative Study

Lemiński

Kaczmarek

Gołąb

et al. 2022

CIA

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Introduction Muscle invasive bladder cancer (MIBC) is a common malignancy amongst elderly. Increasing life expectancy, prevalence of smoking, lifelong exposure to environmental pollutants and immunosenescence contribute to growing number of cases. Traditionally, radical cystectomy (RC) with pelvic lymph node dissection (PLND) constituted the mainstay of treatment for MIBC, but despite proven feasibility in elderly population, it has been associated with significant burden of morbidity, mortality, and complications. Study Objective We aimed to re-evaluate the safety and efficacy of RC amongst the elderly patients with MIBC. Material and Methods This single-center, retrospective, observational comparative study was conducted among 568 patients who underwent RC due to MIBC between 2003 and 2021. We evaluated the influence of chronological age (<70 vs ≥70 years) on clinical, demographic, and pathological variables related to MIBC and RC. Results Elderly patients had similar clinical and pathological features of disease compared to their younger counterparts; nonetheless, they more often received simplified urinary diversion, ie ureterostomy (60.25% vs 39.33%, p<0.001) and had no PLND (15.76% vs 8.5%, p=0.01) during RC. Furthermore, more elderly patients were treated for secondary MIBCs and fewer had history of smoking. Severe complication and 90-day mortality rates were comparable between groups; however, the elderly had significantly higher all-cause mortality at one year post RC (46.67% vs 33.25%, p=0.003). On multivariate analysis, one-year mortality risk was independently associated with elderly age (HR=2.119, 95% CI: 1.227–3.660, p=0.007), rural residency (HR=1.760, 95% CI: 1.043–2.968, p=0.034), extravesical extension of tumor (HR=2.109, 95% CI: 1.155–3.850, p=0.015), lymph node metastasis (HR=2.268, 95% CI: 1.290–3.987, p=0.004) and omission of PLND (HR=6.064, 95% CI: 2.926–12.568, p<0.001). Conclusion Radical cystectomy in elderly patients is associated with significant one-year mortality. Our study emphasizes the unmet need for considerate planning of treatment for MIBC in potentially vulnerable groups of elderly patients. Efforts are needed to reliably identify those unlikely to benefit from surgery and facilitate patient-centered choice of alternative therapies.

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Section: Discussionsupporting

confidence: 89%

Increased One-Year Mortality Among Elderly Patients After Radical Cystectomy for Muscle-Invasive Bladder Cancer: A Retrospective, Observational Comparative Study

Lemiński

Kaczmarek

Gołąb

et al. 2022

CIA

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“…In a retrospective study performed by Hanna et al [18] on 296 patients, it was reported that LOS significantly decreased in the ERAS protocol group (p � 0.004). However, there was no significant difference in the patient group with high comorbidity.…”

Section: Discussionmentioning

confidence: 95%

“…If possible, the most minimally invasive approach should be selected. In addition, the drainage catheter should be removed as soon as possible [18]. In the postoperative period, it is recommended to start enteral feeding within the first 24 hours and encourage mobilization in the first 6 hours.…”

Section: Eras Eras Is the Term Used To Describe The Concept Of Multim...mentioning

confidence: 99%

ERAS vs. Traditional Protocol in Patients Who Had Radical Cystectomy with Ileal Conduit: A Retrospective Comparative Analysis of 182 Cases

Guleser

Basaga

2022

Advances in Urology

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Objective. To examine the effects of ERAS protocol application on hospital stay, postoperative antibiotic use, and gastrointestinal recovery time in radical cystectomy patients with ileal conduit. Materials and Methods. This retrospective study included 182 patients (112 traditional vs. 72 ERAS) who underwent radical cystectomy (RC) with ileal conduit between November 2017 and December 2020. Patients were compared in terms of time to start enteral feeding (SEF), length of hospital stay (LOS), time to first stool, duration of postoperative intravenous antibiotic use, postoperative ileus rate, and serum albumin levels. Results. The traditional and ERAS groups contained 112 and 72 patients, respectively. LOS (14.79 ± 6.44 vs. 10.44 ± 4.64 days, p = 0.003 ), first stool time (4.43 ± 2.39 vs. 2.89 ± 1.81 days, p = 0.011 ), and duration of postoperative intravenous antibiotic use (8.79 ± 5.17 vs. 4.61 ± 4.90, p = 0.004 ) were to be found significantly shorter in the ERAS group. Conclusion. According to the results of this study, the ERAS protocol shortened the length of hospital stay, duration of antibiotic use, and time of first stool in patients who underwent RC with ileal conduit.

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“…In particular, these prevention measures should be implemented in frail patients with a G-8 score ≤13 because they can theoretically reduce the risk of POI. However, Hanna et al 30 found that patients with high levels of comorbidity derived less benefit from the ERAS protocol with subsequent inability to achieve a significant decrease in LOS. 30 Similarly, frail patients might not be able to achieve good ERAS measures and might not derive as much preventive effect compared with their nonfrail counterparts.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for postoperative ileus after robot‐assisted radical cystectomy with intracorporeal urinary diversion

et al. 2022

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Abbreviations & Acronyms ASA = American Society of Anesthesiologists BMI = body mass index CRP = C-reactive protein EBL = estimated blood loss ECUD = extracorporeal urinary diversion ERAS = enhanced recovery after surgery G-8 = Geriatric-8 GI = gastrointestinal ICUD = intracorporeal urinary diversion IQR = interquartile range iRARC = RARC with ICUD LOS = length of hospital stay MIBC = muscle invasive bladder cancer NAC = neoadjuvant chemotherapy NMIBC = nonmuscle invasive bladder cancer POI = postoperative ileus RARC = robot-assisted radical cystectomy RC = radical cystectomy ROC = receiver operating characteristic WBC = white blood cells

show abstract

Enhanced recovery after surgery (ERAS) following radical cystectomy: is it worth implementing for all patients?

Cited by 23 publications

References 27 publications

Increased One-Year Mortality Among Elderly Patients After Radical Cystectomy for Muscle-Invasive Bladder Cancer: A Retrospective, Observational Comparative Study

Increased One-Year Mortality Among Elderly Patients After Radical Cystectomy for Muscle-Invasive Bladder Cancer: A Retrospective, Observational Comparative Study

ERAS vs. Traditional Protocol in Patients Who Had Radical Cystectomy with Ileal Conduit: A Retrospective Comparative Analysis of 182 Cases

Risk factors for postoperative ileus after robot‐assisted radical cystectomy with intracorporeal urinary diversion

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