Reducing post-radical cystectomy complications with enhanced recovery after surgery (ERAS) protocol: is it time to change?

https://doi.org/10.19106/JMedSci005204202007

Ahmad Zulfan Hendri(1*), Muhammad Mauny Puteh(2), Said Alfin Khalilullah(3), Andy Zulfiqqar(4)

(1) Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia.
(2) Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia.
(3) Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia.
(4) Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia.
(*) Corresponding Author

Abstract


Radical cystectomy (RC) remains associated with a greater number of postsurgical complications than any urological procedure. Enhanced recovery after surgery (ERAS) protocol is a multimodal perioperative care pathway designed to achieve early postsurgical recovery. We evaluated the perioperative outcome of post-RC patients, comparing the effectiveness of ERAS to conventional recovery protocols. We identified 37 patients who underwent RC for bladder cancer from 2016 to 2018. The characteristics, complication rate and clinical outcomes were evaluated in these groups of patients. In this study, the mortality was 8.1%, and the complications were 37.8%. The most frequent complications were anastomotic leakage (16.2%), wound dehiscence (13.5%), infections/sepsis (8.1%), and paralytic ileus (8.1%). The ERAS protocol significantly reduced operative time (p=0.001; OR=216; CI95%: 12.0-3855.2) and reduced overall complications (p=0.04; OR= 0.14 CI95%: 0.016-1.132). Extensive complications and mortality develop following the RC procedure. Meanwhile, refinement in perioperative care has been reducing the rate of serious complications. The ERAS protocol distinctly reduces the post-RC complication rate.


Keywords


Bladder cancer; Radical cystectomy; ERAS protocol;

Full Text:

PDF


References

  1. Daneshmand S, Ahmadi H, Schuckman AK, Mitra AP, Cai J, Miranda G, et all. Enhanced recovery protokol after radical cystectomy for bladder cancer. J Urol 2014; 192:50-6. https://doi.org/10.1016/j.juro.2014.01.097
  2. Patel HRH, CerantolaY, Valerio M, Persson B, Jichlinski P, Ljungqvist O, et all. Enhanced recovery after surgery: Are we ready, and can we afford not to implement these pathways for patients undergoing radical cystectomy? European urology 2014; 65:263-6. https://doi.org/10.1016/j.eururo.2013.10.011
  3. Melnyk M, Casey RG, Black P, Koupparis AP. Enhanced recovery after surgery (ERAS) protocols: Time to change practice? Canadian Urological Association journal = Journal de L'Association des urologues du Canada. 2011; 5:342-8. https://doi.org/10.5489/cuaj.11002
  4. Nabhani J, Ahmadi H, Schuckman AK, Cai J, Miranda G, Djaladat H, et all. Cost analysis of the enhanced recovery after surgery protokol in patients undergoing radical cystectomy for bladder cancer. European Urology Focus 2015; 2(1):92-6. https://doi.org/10.1016/j.euf.2015.06.009
  5. Azhar RA, BochnerB, Catto J, Goh AC, Kelly J, Patel HD, et al. Enhanced recovery after urological surgery: A contemporary systematic review of outcomes, key elements, and research needs. Eur Urol 2016; 70(1):176-78. https://doi.org/10.1016/j.eururo.2016.02.051
  6. Danna BJ, Wood EL, Kukreja JEB, Shah JB. The future of enhanced recovery for radical cystectomy: Current evidence, barriers to adoption, and the next steps. Urology 2016; 96:62-8. https://doi.org/10.1016/j.urology.2016.04.038
  7. Tyson MD, Chang SS. Enhanced recovery pathway versus standard care after cystectomy: A meta-analysis of the effect on perioperative outcomes. Eur Urol 2016; 70(6):995-1003. https://doi.org/10.1016/j.eururo.2016.05.031
  8. Cerantola Y, Valerio M, Persson B, Jichlinski P, Ljungqvist O, Hubner M, et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS?) society recommendations. Clin Nutr 2013; 32(6):879-87. https://doi.org/10.1016/j.clnu.2013.09.014
  9. McGrath J. Adopting enhanced recovery programmes in radical cystectomy: can we afford not to? Eur Urol Focus 2016 2(1):97-8. https://doi.org/10.1016/j.euf.2015.08.003
  10. Preston MA, Lerner SP, Kibel AS. New trends in the surgical management of invasive bladder cancer. Hematol Oncol Clin N Am 2015; 29(2):253-69. https://doi.org/10.1016/j.hoc.2014.10.010
  11. Karl A, Buchner A, Becker A, Staehler M, Seitz M, Khoder W, et al. A new concept for early recovery after surgery for patients undergoing radical cystectomy for bladder cancer: Results of a prospective randomized study. J Urol 2014; 191(2):335-40. https://doi.org/10.1016/j.juro.2013.08.019
  12. Devane LA, Proud D, O'Connell PR, Panis Y. A European survey of bowel preparation in colorectal surgery. Colorectal Dis 2017; 19(11):402-6. https://doi.org/10.1111/codi.13905
  13. Bucher P, Mermillod B, Gervaz P, Morel P. Mechanical bowel preparation for elective colorectal surgery: a meta-analysis. Arch Surg 2004; 139(12):1359-64. https://doi.org/10.1001/archsurg.139.12.1359
  14. Liu B, Domes T, Jana K. Evaluation of an enhanced recovery protocol on patients having radical cystectomy for bladder cancer. Can Urol Assoc J 2018; 12(12):421-6. https://doi.org/10.5489/cuaj.5273
  15. Wayan Y, Ayu PD, Gde OAA, Wayan N, Widyadharma IPE. Pathological profile, early complications, functional and oncological outcome after radical cystectomy - ileal conduit for bladder cancer patients in Sanglah General Hospital between January 2013 and December 2016. J Med Sci 2018; 6(9):1647-51. https://doi.org/10.3889/oamjms.2018.384



DOI: https://doi.org/10.19106/JMedSci005204202007

Article Metrics

Abstract views : 2200 | views : 2242


Bookmark and Share


Copyright (c) 2020 Ahmad Zulfan Hendri, Muhammad Mauny Puteh, Said Alfin Khalilullah, Andy Zulfiqqar

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.