Fast-track surgery and technical nuances to reduce complications after radical cystectomy and intestinal urinary diversion with the modified Indiana pouch

Maffezzini, Massimo; Campodonico, Fabio; Capponi, Giacomo; Manuputty, Egi Edward; Gerbi, Guido

doi:10.1016/j.suronc.2012.02.001

Cited by 50 publications

(25 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…229 Evidence in colorectal surgery also supports the use of epidurals to dampen the stress response, provide superior pain relief, hasten functional recovery, and to reduce cardiopulmonary complications. 230 In the colorectal setting, the optimal duration of epidurals is between 48 and 72 hours after surgery.…”

Section: Discussionmentioning

confidence: 99%

Recommendations for the improvement of bladder cancer quality of care in Canada: A consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA), December 2015

Kassouf

Aprikian

Black

et al. 2016

CUAJ

View full text Add to dashboard Cite

This initiative was undertaken in response to concerns regarding the variation in management and in outcomes of patients with bladder cancer throughout centres and geographical areas in Canada. Population-based data have also revealed that real-life survival is lower than expected based on data from clinical trials and/or academic centres. To address these perceived shortcomings and attempt to streamline and unify treatment approaches to bladder cancer in Canada, a multidisciplinary panel of expert clinicians was convened last fall for a two-day working group consensus meeting. The panelists included urologic oncologists, medical oncologists, radiation oncologists, patient representatives, a genitourinary pathologist, and an enterostomal therapy nurse. The following recommendations and summaries of supporting evidence represent the results of the presentations, debates, and discussions. Methodology

show abstract

Section: Discussionmentioning

confidence: 99%

Recommendations for the improvement of bladder cancer quality of care in Canada: A consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA), December 2015

Kassouf

Aprikian

Black

et al. 2016

CUAJ

View full text Add to dashboard Cite

show abstract

“…Evidence often quoted supporting use of TEA in reduction of short-term complications in RC come from the ERAS literature. 29 The ERAS studies are investigating several perioperative interventions simultaneously, so to attribute improvements in short-term complications to one aspect of the intervention -TEA -is not likely appropriate. Our best evidence then, must be extrapolated from mixed surgical populations.…”

Section: Discussionmentioning

confidence: 99%

Is there a measurable association of epidural use at cystectomy and postoperative outcomes? A population-based study

d’Oiron

Jaeger

Booth

et al. 2016

CUAJ

View full text Add to dashboard Cite

Introduction: Thoracic epidural analgesia (TEA) is commonly used to manage postoperative pain and facilitate early mobilization after major intra-abdominal surgery. Evidence also suggests that regional anesthesia/analgesia may be associated with improved survival after cancer surgery. Here, we describe factors associated with TEA at the time of radical cystectomy (RC) for bladder cancer and its association with both short-and long-term outcomes in routine clinical practice. Conclusions:In routine clinical practice, 54% of RC patients received TEA and its use was associated with anesthesiologist provider volume. After controlling for patient, disease and provider variables, we were unable to demonstrate any effect on either short-or long-term outcomes at the time of RC.

show abstract

“…At present, the data on fast track surgery in urology are rather limited [9,24,25,26,27,28,29,30,31]. In 2002 the Vanderbilt University group developed a fast track protocol for uro-oncological surgery (i.e.…”

Section: Discussionmentioning

confidence: 99%

Fast Track Surgery to Reduce Short-Term Complications following Radical Cystectomy and Intestinal Urinary Diversion with Vescica Ileale Padovana Neobladder: Proposal for a Tailored Enhanced Recovery Protocol and Preliminary Report from a Pilot Study

Cerruto

Marco²,

D’Elia³

et al. 2013

Urol Int

View full text Add to dashboard Cite

Objective: Different fast track programs for patients undergoing radical cystectomy (RC) can be found in the current literature. The aim of this work was to develop a new enhanced recovery protocol (ERP). Patients and Methods: The ERP was designed after a structured literature review focusing on reduced bowel preparation, standardized feeding, postoperative nausea, vomiting and pain control. In order to test the ERP, a pilot observational prospective cohort study was planned, enrolling all patients consecutively undergoing RC and Vescica Ileale Padovana (VIP) neobladder. These patients were compared with a matched group of subjects who had undergone RC and VIP neobladder before implementation of the ERP. To achieve good comparability, a propensity score-matching was performed. The primary aim was to assess the ERP's feasibility; the secondary outcome measures were early morbidity and mortality. Results and Limitations: After an exhaustive literature search and a multidisciplinary consultation, an ERP was designed. Nine consecutive patients participated in the pilot study and were compared to 13 patients treated before implementation of the ERP. We did not find any statistically significant difference in terms of mortality rate (none died peri- or postoperatively in both groups). The complication rate, according to the modified Clavien classification, was significantly lower in the ERP group (22.22 vs. 84.61%, p < 0.004). The major limitations are the low number of patients enrolled to test the protocol and the lack of randomization for the comparative evaluations. Conclusion: The introduction of our ERP was proven to be feasible in the management of patients undergoing RC and intestinal urinary diversion with VIP neobladder. The postoperative course was enhanced by a significant reduction in both nasogastric tube insertion and parenteral nutrition support, with early postoperative feeding. All these findings were associated with no deleterious effect on morbidity or mortality, indeed there was a reduced occurrence of postoperative complication rates.

show abstract

Fast-track surgery and technical nuances to reduce complications after radical cystectomy and intestinal urinary diversion with the modified Indiana pouch

Cited by 50 publications

References 14 publications

Recommendations for the improvement of bladder cancer quality of care in Canada: A consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA), December 2015

Recommendations for the improvement of bladder cancer quality of care in Canada: A consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA), December 2015

Is there a measurable association of epidural use at cystectomy and postoperative outcomes? A population-based study

Fast Track Surgery to Reduce Short-Term Complications following Radical Cystectomy and Intestinal Urinary Diversion with Vescica Ileale Padovana Neobladder: Proposal for a Tailored Enhanced Recovery Protocol and Preliminary Report from a Pilot Study

Contact Info

Product

Resources

About