Updates on enhanced recovery after surgery for radical cystectomy

Abstract

Enhanced Recovery after Surgery (ERAS) is a multimodal pathway that provides evidence-based guidance for improving perioperative care and outcomes in patients undergoing surgery. In 2013, the ERAS society released its original guidelines for radical cystectomy (RC) for bladder cancer (BC), adopting much of its supporting data from colorectal literature. In the last decade, growing interest in ERAS has increased RC-specific ERAS research, including prospective randomized controlled trials (RCTs). Collective data suggest ERAS contributes to improved complication rates, decreased hospital length-of-stay, and/or time to bowel recovery. Various institutions have adopted modified versions of the ERAS pathway, yet there remains a lack of consensus on the efficacy of specific ERAS items and standardization of the protocol. In this review, we summarize updated evidence and practice patterns of ERAS pathways for RC since the introduction of the original 2013 guidelines. Novel target interventions, including use of immunonutrition, prehabilitation, alvimopan, and methods of local analgesia are reviewed. Finally, we discuss barriers to implementing and future steps in advancing the ERAS movement.

Is analgesic efficacy of rectus sheath catheter actually non‐inferior to thoracic epidural catheter?

“…Second, postoperative analgesia managements in both groups allowed administration of non-opioid analgesics including acetaminophen and NSAIDs, but none of them were given on a dosing schedule. This does not meet the needs of an opioid-sparing multimodal analgesia strategy recommended by the current enhanced recovery after surgery practices for radical cystectomy [4], in which administration of non-opioid analgesics is required to start before or during operation and regularly repeat after surgery. Importantly, the authors did not report if total dosages of acetaminophen and NSAIDs during the study period were comparable between groups.…”

“…This is also not true. The indolent nature of Gleason score 3 + 3 tumours has been verified by the 15-year outcome data from the Prostate Testing for Cancer and Treatment (ProtecT) trial [4]. Finally, Takahashi goes on to state that there is 'little to no benefit and considerable harm' to PSA testing and cites the recommendations of the United States Preventive Services Task Force.…”

Comparative analysis of wound healing techniques in postoperative bladder cancer patients

“…The postoperative phase of bladder cancer surgery holds great importance due to the substantial impact that rate and quality of wound healing have on patient's recovery trajectory and overall quality of life. 13,14 The domain of wound management has thus generated significant attention, leading to upsurge in scholarly investigations focused on enhancing healing methodologies. 15 Surgical procedures for managing bladder cancer can vary in intensity from transurethral resection to cystectomy and inherently entail the range of postoperative complications.…”

“…The unwavering dedication to progress in medicine has significantly improved the quality of patient care, specifically with regard to the period following surgical procedures. The postoperative phase of bladder cancer surgery holds great importance due to the substantial impact that rate and quality of wound healing have on patient's recovery trajectory and overall quality of life 13,14 . The domain of wound management has thus generated significant attention, leading to upsurge in scholarly investigations focused on enhancing healing methodologies 15 …”