Abstract
PurposeCystectomy for bladder cancer is associated with a high risk of postoperative complications. Standardized perioperative protocols, such as enhanced recovery after surgery (ERAS) protocols, aim to improve postoperative outcome. Postoperative feeding strategies are an important part of these protocols. In this two-centre study, we compared complications and length of hospital stay (LOS) between an ERAS protocol with early oral nutrition and a protocol with early enteral feeding with a Bengmark nasojejunal tube.MethodsWe retrospectively reviewed 154 consecutive patients who underwent cystectomy for bladder cancer in two hospitals (Hospital A and B) between 2014 and 2016. Hospital A uses an ERAS protocol (n = 45), which encourages early introduction of an oral diet. Hospital B uses a fast-track protocol comprising feeding with a Bengmark nasojejunal tube (Bengmark-protocol, n = 109). LOS and complications according to Clavien classification were compared between protocols.ResultsOverall 30-day complication rates in the ERAS and Bengmark protocol were similar (64.4 and 67.0%, respectively; p = 0.463). The rate of postoperative ileus (POI) was significantly lower in the Bengmark protocol (11.9% vs. 34.4% in the ERAS protocol, p = 0.009). This association remained significant after adjustment for other variables (odds ratio 0.32, 95% confidence interval 0.11–0.96; p = 0.042). Median LOS did not differ significantly between protocols (10 days vs. 11 days in the ERAS and Bengmark protocols, respectively; p = 0.861).ConclusionsEarly oral nutrition in Hospital A was well tolerated. However, the Bengmark protocol was superior with respect to occurrence of POI. A prospective study may clarify whether the lower rate of POI was due to the use of early nasojejunal tube feeding or other reasons.
Highlights
Radical cystectomy (RC) for bladder cancer (BC) is associated with a high complication rate
postoperative ileus (POI) is an important reason for prolonged length of hospital stay (LOS) after RC [4,5,6]
Patient characteristics In Hospital A, 50 patients were treated in the enhanced recovery after surgery (ERAS) protocol versus 121 patients in Hospital B in the Bengmark protocol
Summary
Radical cystectomy (RC) for bladder cancer (BC) is associated with a high complication rate. Thirty-day overall complication rates vary from 26 to 78% with mortality rates of 1.0–4.0% [1,2,3]. The most common complications are infectious or gastrointestinal related, with postoperative ileus (POI) as one of the most frequent [4]. POI is an important reason for prolonged length of hospital stay (LOS) after RC [4,5,6]. Attempts have been made to improve recovery and reduce LOS by introducing enhanced recovery after surgery (ERAS) programmes. Their objective is to minimize physiologic stress effects in major surgery and
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