Enhanced Recovery after Surgery (ERAS) Protocols versus Standard Care in Perioperative Management of Radical Cystectomy with Urinary Diversion

Abstract

Abstract Background Bladder cancer is the ninth most common cancer worldwide, with an estimated 430 000 new cases in 2012. Bladder cancer has more than 130,000 deaths per year worldwide, with an estimated male: female ratio of 3.8:1.0. Aim of the Work to examine the current evidence for ERAS in preoperative, intraoperative and post-operative setting of care for RC patients, to propose ERAS evidence-based protocol for patients undergoing Radical Cystectomy in Egypt environment and to compare the effectiveness of ERAS versus standard care on perioperative outcomes after cystectomy including Length of Hospital Stay,bowel movement, Complications and Readmission Rate in 30Day. Patients and Methods This is a prospective randomized comparative study done at the urology departments of Ain Shams University and Nasser institute for research and treatment in 2018. Forty patients were included in this study who were indicated For Radical Cystectomy. They were recruited and randomized in two groups: Group A: where they followed enhanced recovery after Surgery protocols and Group B: where they followed the the classic pre-operative and post-operative protocols. Results We finished to that Enhanced recovery after surgery (ERAS) protocols in radical cystectomy is safe and not associated with any increase in intraoperative and post-operative complications compared to standard protocol. It is associated with reductions in the length of hospital stay, time to return to full diet, time to flatulence, time for defecation and pain post-operative. There is no difference in 30 day readmission rate between ERAS and Standard Care. Our prospective randomized controlled trial covers most of the items recommended for ERAS excluding the use of a laparoscopic or robotic approach, Audit, and use of alvimopan, a peripherally acting μ-opioid antagonist, which is not available in Egypt. Our study reveals many issues that need to be considered when designing a larger more powered study. Conclusion Enhanced recovery after surgery (ERAS) protocols in radical cystectomy is safe and not associated with any increase in intraoperative and post-operative complications compared to standard protocol. It is associated with reductions in the length of hospital stay, time to return to full diet, time to flatulence, time for defecation and pain post operative. There is no difference in 30 day readmission rate between ERAS and Standard Care.