MP55-10 GASTROINTESTINAL RECOVERY USING PERIOPERATIVE ALVIMOPAN WITH ROBOTIC CYSTECTOMY AND URINARY DIVERSION

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive II1 Apr 2014MP55-10 GASTROINTESTINAL RECOVERY USING PERIOPERATIVE ALVIMOPAN WITH ROBOTIC CYSTECTOMY AND URINARY DIVERSION Daniel Swanson, Ross E. Anderson, Ann C. Martinez Acevedo, Jeffrey C. La Rochelle, Theresa M. Koppie, and Christopher L. Amling Daniel SwansonDaniel Swanson More articles by this author , Ross E. AndersonRoss E. Anderson More articles by this author , Ann C. Martinez AcevedoAnn C. Martinez Acevedo More articles by this author , Jeffrey C. La RochelleJeffrey C. La Rochelle More articles by this author , Theresa M. KoppieTheresa M. Koppie More articles by this author , and Christopher L. AmlingChristopher L. Amling More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1558AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Postoperative ileus contributes significantly to the morbidity associated with radical cystectomy and urinary diversion. Alvimopan, a peripheral acting μ-opioid receptor antagonist, has been shown to accelerate gastrointestinal recovery following bowel resection. Robotic cystectomy may also shorten postoperative ileus compared to open cystectomy. We investigate gastrointestinal recovery and length of hospital stay (LOS) using perioperative alvimopan with particular attention to whether there is added benefit to this drug in patients undergoing robotic cystectomy and urinary diversion. Methods Over a two year period (2011-2013), a total of 58 patients with bladder cancer underwent robotic cystectomy with urinary diversion. Of this group, 37 did not receive perioperative alvimopan while 21 more recently treated patient got alvimopan starting preoperatively and continued postoperatively as directed. All patients received the standard bowel recovery protocol. Return of bowel function, defined by time to first flatus and time to bowel movement (BM), was compared between these groups. Hospital LOS and gastrointestinal complications were also evaluated. Results There was no difference between alvimopan-treated or untreated groups with regard to gender distribution, age, BMI, bladder cancer pathologic stage or urinary diversion option. There was no difference between the groups with regard to operative time, estimated blood loss, or intravenous fluid volume. Time to first flatus (2.5 versus 3.6 days, p=0.001) and bowel movement (3.3 versus 4.7 days, p=0.001) were significantly shorter in those patients who received alvimopan. In addition, hospital LOS (4.5 versus 7.5 days, p=0.009) was significantly reduced in the alvimopan cohort. There were no patients with prolonged ileus in the alvimopan group and no difference between the groups in hospital readmission rates or gastrointestinal complications. Conclusions In our experience, perioperative use of alvimopan significantly accelerates gastrointestinal recovery and hospital discharge, even in patients undergoing robotic cystectomy which itself is associated with a shorter hospital stay than open cystectomy at our institution. The combination of a robotic approach and perioperative alvimopan may result in the shortest possible time to bowel recovery and hospital discharge, reducing cost and limiting perioperative complications. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e559 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Daniel Swanson More articles by this author Ross E. Anderson More articles by this author Ann C. Martinez Acevedo More articles by this author Jeffrey C. La Rochelle More articles by this author Theresa M. Koppie More articles by this author Christopher L. Amling More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...