Prospective Implementation of Enhanced Recovery After Surgery Protocols to Radical Cystectomy

Pang, Karl H.; Groves, Ruth; Venugopal, Suresh; Noon, Aidan P.; Catto, James W.F.

doi:10.1016/j.eururo.2017.07.031

Cited by 151 publications

(83 citation statements)

References 20 publications

(31 reference statements)

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“…We could show that protocols differ in number and manner of included ERAS items. Furthermore, the implementation of every EP item is usually impossible in every patient rendering the assessment of EPs and especially the value of each single item difficult [31]. There are recommendations by the ERAS-Society regarding the content of a protocol for RC [4].…”

Section: Discussionmentioning

confidence: 99%

Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

et al. 2020

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Purpose Different enhanced recovery after surgery (ERAS) protocols (EP) for radical cystectomy (RC) have been published. Protocols highly differ in number of included items and specific measures. Materials and methods A systematic review and meta-analysis on EPs in RC were performed using the databases MedLine, Cochrane Library, Web of science, and Google Scholar. The specific ERAS measures of the protocols were extracted, analyzed, and compared. Pooling of available outcome data was performed for length of stay, complications, readmission rate, and time to defecation. Results The search yielded a total of 860 studies of which 25 studies were included in qualitative and 22 in quantitative analysis. Oral bowel preparation (BP) was omitted in 24/25 (96%) EPs, optimized fluid management was administered in 22/25 (88%) EPs and early mobilization (postoperative day 1) in 21/25 (84%). Gum chewing (n = 12, 46%), metoclopramide (n = 11, 44%), and alvimopan (n = 6, 24%) were the most common measures to prevent postoperative ileus. Our meta-analysis revealed a significant benefit in favor of EPs for the outcome parameters length of stay [mean difference (MD) − 3.46 d, 95% confidence interval (CI) − 4.94 to − 1.98, p < 0.01], complications [Odds ratio (OR) = 0.76, 95% CI 0.61-0.94, p = 0.01] and time to defecation (MD − 1.37 d, 95% CI − 2.06 to − 0.69, p < 0.01). Readmission rate did not show a significant difference (OR = 0.73, 95% CI 0.52-1.03, p = 0.07). Conclusion Current EPs focus on omitting oral BP, early mobilization, and optimized fluid management while they differ in methods preventing postoperative ileus. Our meta-analysis revealed a benefit in introducing these protocols into clinical practice.

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Section: Discussionmentioning

confidence: 99%

Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

et al. 2020

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“…It seems logical that if a physician delays definitive treatment for a period of time (eg, for a trial of BCG) and finds a progressing invasive tumour, then the patient outcome will be worse than that if the patient is treated with immediate definitive radical cystectomy. Given improvements in radical cystectomy [26], one would wonder whether the time for primary cystectomy is now.…”

Section: Is Delay Of Radical Cystectomy Detrimental?mentioning

confidence: 99%

How to Treat a Patient with T1 High-grade Disease and No Tumour on Repeat Transurethral Resection of the Bladder?

Shariat

Catto

2021

European Urology Oncology

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This case presents a 64-yr-old, healthy man who noted microscopic haematuria and immediately sought an appointment with the physician. He was a long-term heavy smoker, which alerts the physician to bladder cancer. The standard practice in Austria includes an ultrasound scan, which revealed a small lesion in the bladder of this patient. Cytology is suspicious for high-grade cancer, and transurethral resection of the bladder (TURB) reveals a single primary unifocal 2.0-cm tumour on the left side. During TURB with blue light using hexaminolevulinate (Hexvix), there were two foci of concomitant carcinoma in situ (CIS). The pathology revealed PT1 high grade without lymphovascular invasion or variant histology, with two foci of CIS, that is, a pure urothelial T1 2.0-cm unifocal nonmuscle-invasive bladder cancer (NMIBC) lesion. At this point, the physician opted for a repeat TURB (re-TURB). This revealed no residual tumour, and the computed tomography (CT) urogram was normal as well. The question is: What is the best treatment for this patient? 2. Option A: the case for conservative therapy Why should we choose conservative intravesical treatment in this patient-a healthy 64-yr-old man with T1 grade 3

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“…Im Gegenteil sind ‚Fast-Track'-Verfahren empfohlen [8], so z. B. implementiert im ERAS-Schema [17,18]. Diese beinhalten neben dem zügigen oralen Kostaufbau verschiedene Aspekte, von der frühen Mobilisation der Patienten über die Reduktion opioider Schmerzmittel bis hin zur Vermeidung von Magensonden.…”

Section: Evidenzbasierte Konzepte Des Perioperativen Managementsunclassified

Sicher zwischen Leitlinie und Leitplanke: Umfrage zur Praxis des perioperativen Managements der radikalen Zystektomie in Deutschland

et al. 2020

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Zusammenfassung Hintergrund und Zielsetzung Die radikale Zystektomie (RCX) ist die kurative Standardbehandlung für muskelinvasive Harnblasenkarzinome. Aufgrund des operativen Ausmaßes und der damit verbundenen komplexen stationären Betreuung ist die RCX mit hoher Morbidität und Mortalität verbunden. Ziel war es, Daten aus dem klinischen Alltag zur gegenwärtigen Praxis des perioperativen Managements zu erfassen. Methoden Mitglieder der DGU und der German Society of Residents in Urology beantworteten anonym einen 24 Fragen umfassenden Online-Fragebogen. Gegenstand waren sowohl klinisch relevante Aspekte der gegenwärtigen EAU/DGU-Leitlinien als auch kontrovers diskutierte klinische Fragen. Ergebnisse Durch die Teilnehmer konnten mindestens 19 % aller infrage kommenden deutschen Zentren erfasst werden. Mehrheitlich wird das präoperative Staging mittels CT-Urografie und CT-Thorax durchgeführt. Die meistgenutzte Antibiotikaprophylaxe umfasst ein Drittgenerations-Cephalosporin plus Metronidazol (46 %), welche im Median für 5 Tage verabreicht werden. Harnleiterschienen (HS) werden im Mittel beim Ileumconduit am 11. und bei der Neoblase am 12. Tag nach RCX entfernt. Gemessen an Surrogatparametern wie oraler Darmvorbereitung, Beginn des Kostaufbaus und Einsatz einer Magensonde sind aktuelle Fast-Track-Konzepte noch nicht allgemein verbreitet (< 50 %). Schlussfolgerungen Die meisten Aspekte des perioperativen Managements werden leitliniengerecht durchgeführt, so z. B. Staging-Untersuchungen, Einsatz von Antibiotika und Entfernung der HS. Andere klinische Fragestellungen wie Durchführung einer Bildgebung vor Entfernung der HS und Fast-Track-Konzepte werden unterschiedlich gehandhabt, obwohl zunehmende Evidenz in diesen Bereichen existiert. Leitlinienadhärenz war nicht mit Zentrumsgröße oder Anzahl der Eingriffe assoziiert.

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Prospective Implementation of Enhanced Recovery After Surgery Protocols to Radical Cystectomy

Abstract: Recovery after major bladder surgery can be improved by using enhanced recovery pathways. Patients managed by these pathways have shorter length of stays, lower blood loss, and lower transfusion rates. Their adoption should be encouraged.

Cited by 151 publications

References 20 publications

Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

How to Treat a Patient with T1 High-grade Disease and No Tumour on Repeat Transurethral Resection of the Bladder?

Sicher zwischen Leitlinie und Leitplanke: Umfrage zur Praxis des perioperativen Managements der radikalen Zystektomie in Deutschland

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