The study retrospectively reviewed the records of 2111 patients who underwent radical cystectomy for primary urothelial bladder carcinoma between January 2003 and August 2022. Of these, 967 patients were managed under ERAS protocols, while 1144 were not. The primary focus was on assessing recurrence-free survival (RFS) and overall survival (OS) rates among these cohorts, using multivariable Cox regression analysis to adjust for various patient and tumor characteristics.
The study found that while ERAS protocols significantly reduced the length of hospital stay and were associated with better OS rates in univariate analysis, they did not independently impact long-term oncologic outcomes when adjusting for other pertinent factors. Specifically, the adjusted analysis showed no significant association between ERAS protocols and both recurrence-free and overall survival, suggesting that the immediate perioperative benefits of ERAS do not translate into improved long-term cancer control.
This comprehensive examination of ERAS protocols within the context of radical cystectomy fills a gap in current medical literature, providing critical evidence that while ERAS can enhance perioperative care and potentially improve short-term outcomes, it does not influence the oncologic effectiveness of the surgery. These findings underscore the importance of maintaining a focus on traditional oncological principles and strategies to improve long-term outcomes in bladder cancer patients.
Moreover, the study highlights the complexity of surgical oncology care, where advancements in perioperative management must be continually balanced with the fundamental goals of cancer surgery. The findings from this study are particularly relevant for urologists, oncologists, and healthcare professionals involved in the surgical management of bladder cancer, providing a foundation for future research and clinical practice guidelines that aim to optimize patient outcomes both perioperatively and long-term cancer control.
Written by:
- Runzhuo Ma, MD, Research Fellow, Institute of Urology, University of Southern California, Los Angeles, CA
- Hooman Djaladat, MD, MS, Professor of Clinical Urology, Institute of Urology, University of Southern California, Los Angeles, CA
- M. Melnyk, R.G. Casey, P. Black, et al., Enhanced recovery after surgery (ERAS) protocols: time to change practice? Can. Urol. Assoc. J. 5 (2011) 342–348
- S. Daneshmand, H. Ahmadi, A.K. Schuckman, et al., Enhanced recovery protocol after radical cystectomy for bladder cancer, J. Urol. 192 (2014) 50–55.
- C. Llorente, A. Guijarro, V. Hernández, et al., Outcomes of an enhanced recovery after radical cystectomy program in a prospective multicenter study: compliance and key components for success, World J. Urol. 38 (2020) 3121–3129.
- Ma R, Sheybaee Moghaddam F, Ghoreifi A, et al., The effect of enhanced recovery after surgery on oncologic outcome following radical cystectomy for urothelial bladder carcinoma. Surg Oncol. 2024 Mar 8;54:102061.