OBJECTIVE: Early recovery after surgery (ERAS) concepts have gained wide acceptance in various surgical specialities.
However, limited data are available for radical cystectomy. A new ERAS concept was compared to a more conservative regimen (CR) in patients undergoing radical cystectomy for bladder cancer.
MATERIALS AND METHODS: 101 consecutive patients were prospectively randomized to ERAS (n=62) or CR (n=39) (intended randomization ERAS:CR=2:1). Primary endpoints were differences in quality of life; secondary endpoints included postoperative morbidity, demand of analgesics, time spent at intermediate care unit, mobility and number of gastrointestinal events during hospital stay.
RESULTS: Quality of life parameters, as measured by the EORTC-QLQ-30, did not change significantly between day 3, 7 and at discharge in CR whereas a significant improvement was observed in the ERAS group. Postoperative morbidity was lower for ERAS regarding wound healing disorders (p=0.006), fever (0.004), and thrombosis (0.027). Demand for analgesics was significantly lower for ERAS; the amount of consumed food in relation to the amount of offered food was significantly higher for ERAS as soon as day 3 (p=0.02). Time spent at intermediate care unit was significantly shorter for ERAS (p< 0.001). There were no significant differences with respect to gastrointestinal events. Main limitations of this study are the lack of long term data as well as the single center approach.
CONCLUSIONS: ERAS in patients after radical cystectomy appears to have significant benefits as compared to a conservative regimen with regard to postoperative morbidity, quality of life, use of analgesics and time spent at the ICU.
Written by:
Karl A, Buchner A, Becker A, Staehler M, Seitz M, Khoder K, Schneevoigt B, Weninger E, Rittler P, Grimm T, Gratzke C, Stief C. Are you the author?
Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
Reference: J Urol. 2013 Aug 19. pii: S0022-5347(13)05139-2.
doi: 10.1016/j.juro.2013.08.019
PubMed Abstract
PMID: 23968966
UroToday.com Bladder Cancer Section
