Enhanced recovery after surgery (ERAS) protocols: Time to change practice?

Area of Science:

• Urology
• Surgical Oncology
• Perioperative Medicine

Background:

• Radical cystectomy with pelvic lymph node dissection is the standard for muscle invasive bladder cancer.
• This procedure has significant morbidity and prolonged hospital stays compared to other urological surgeries.
• Enhanced Recovery After Surgery (ERAS) protocols offer a multimodal approach to improve patient recovery.

Purpose of the Study:

• To discuss key elements of ERAS protocols in the context of radical cystectomy.
• To highlight shifts in surgical practice, including perioperative nutrition, ileus management, and bowel preparation.

Main Methods:

• Review of ERAS protocol components: preoperative counseling, nutritional optimization, standardized anesthesia and analgesia, early mobilization.
• Discussion of specific ERAS elements impacting traditional surgical doctrine.
• Focus on perioperative nutrition, postoperative ileus management, and mechanical bowel preparation.

Main Results:

• ERAS protocols are designed to maintain organ function and reduce surgical stress response.
• Evidence suggests ERAS protocols lead to improved patient outcomes.
• Implementation of ERAS protocols has been slow due to challenges to traditional surgical practices.

Conclusions:

• ERAS protocols represent a fundamental shift in perioperative care for radical cystectomy.
• Optimizing nutrition, managing ileus, and appropriate bowel preparation are crucial components.
• Wider adoption of ERAS protocols is needed to improve patient recovery and reduce healthcare costs.