Enhanced Recovery after Radical Cystectomy

Enhanced Recovery after Surgery (ERAS) programs are multimodal and interdisciplinary protocols, which aim to accelerate patient recovery and improve surgical outcomes through standardized perioperative care. In this review, we summarized the items included in most currently utilized protocols for patients undergoing radical cystectomy and we discussed the reported outcomes after the implementation.

Current protocols are mostly extrapolated from the colorectal surgery literature, and solid evidence in radical cystectomy is limited. Moreover, the items included in the protocols differ between countries and institutions, which make it difficult to quantify the individual contribution of each intervention to the overall effect of the ERAS program. Length of hospital stay (LOS), commonly used as a surrogate outcome of perioperative recovery, is reported to be lower for patients who benefited from an ERAS protocol. Complications and readmission rates showed no benefit to the ERAS protocols in most studies.

Although randomized controlled trials are needed to determinate the effect of the different items on patient recovery and the overall impact of ERAS program, available data support these protocols for patients undergoing radical cystectomy leading to a shorter LOS without increasing readmission or complication rates.