Challenging boundaries: an enhanced recovery programme for radical cystectomy

Area of Science:

• Urology
• Surgical Oncology
• Critical Care Medicine

Background:

• Enhanced recovery programmes (ERPs) have improved outcomes in colorectal surgery.
• The application of ERPs in radical cystectomy (RC) warrants investigation.
• This study evaluates the impact of an ERP on RC at a single institution.

Purpose of the Study:

• To assess the safety and efficacy of an ERP in patients undergoing radical cystectomy.
• To compare outcomes between patients who underwent RC with and without an ERP.
• To identify specific benefits of ERP implementation in RC.

Main Methods:

• A prospective study comparing 26 patients before ERP implementation with 51 patients after ERP implementation for open radical cystectomy.
• ERP protocol included preoperative carbohydrate drinks, perioperative epidural analgesia, and early mobilization.
• Key outcomes measured were intensive care unit (ICU) and hospital length of stay, time to flatus/faeces passage, and complication rates.

Main Results:

• The ERP group showed a significant reduction in mean ICU stay (2.4 to 1.0 days, p=0.01).
• Median hospital stay decreased from 11.5 to 10.4 days.
• Time to nasogastric tube removal, passage of flatus/faeces, and full oral diet were shorter in the ERP group, with similar complication and 30-day mortality rates.

Conclusions:

• Enhanced recovery programmes are safe for radical cystectomy patients.
• ERPs do not increase complication or readmission rates.
• ERPs can reduce ICU stay, hospital length of stay, and duration of postoperative ileus in radical cystectomy.