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Enhanced recovery cystectomy

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https://www.readbyqxmd.com/read/28801130/prospective-implementation-of-enhanced-recovery-after-surgery-protocols-to-radical-cystectomy
#1
Karl H Pang, Ruth Groves, Suresh Venugopal, Aidan P Noon, James W F Catto
BACKGROUND: Multimodal enhanced recovery after surgery (ERAS) regimens have improved outcomes from colorectal surgery. OBJECTIVE: We report the application of ERAS to patients undergoing radical cystectomy (RC). DESIGN, SETTING, AND PARTICIPANTS: Prospective collection of outcomes from consecutive patients undergoing RC at a single institution. INTERVENTION: Twenty-six components including prehabilitation exercise, same day admission, carbohydrate fluid loading, targeted intraoperative fluid resuscitation, regional local anaesthesia, cessation of nasogastric tubes, omitting oral bowel preparation, avoiding drain use, early mobilisation, chewing gum use, and audit...
August 8, 2017: European Urology
https://www.readbyqxmd.com/read/28753885/gastrointestinal-complications-following-radical-cystectomy-using-enhanced-recovery-protocol
#2
Soroush T Bazargani, Hooman Djaladat, Hamed Ahmadi, Gus Miranda, Jie Cai, Anne K Schuckman, Siamak Daneshmand
BACKGROUND: The development of enhanced recovery after surgery (ERAS) protocols for patients undergoing radical cystectomy (RC) represents a significant advance in perioperative care. OBJECTIVE: To evaluate gastrointestinal (GI) complications following RC and urinary diversion (UD) using our institutional ERAS protocol. DESIGN, SETTING, AND PARTICIPANTS: We identified 377 consecutive cases of open RC and UD for which our ERAS protocol was used from May 2012 to December 2015...
April 25, 2017: European Urology Focus
https://www.readbyqxmd.com/read/28648412/renal-outcome-after-radical-cystectomy-and-urinary-diversion-performed-with-restrictive-hydration-and-vasopressor-administration-in-the-frame-of-an-enhanced-recovery-program-a-follow-up-study-of-a-randomized-clinical-trial
#3
Fiona Mei Wen Wu, Fiona Burkhard, Filippo Turri, Marc Furrer, Lukas Loeffel, George Thalmann, Patrick Wuethrich
OBJECTIVE: To determine whether a restrictive perioperative fluid management in the context of an enhanced recovery after surgery program for radical cystectomy and urinary diversion affects renal function, as fluid restriction and the use of vasopressors have been linked to impaired tissue perfusion, potentially resulting in renal dysfunction. METHODS: We followed 166 patients initially included in a randomized clinical trial and equally allocated to receive a continuous norepinephrine administration combined with 1ml/kg/h initially, and after cystectomy 3ml/kg/h crystalloid infusion (intervention group, n = 83), or a standard crystalloid infusion of 6ml/kg/h throughout surgery (control group, n = 83)...
June 22, 2017: Urologic Oncology
https://www.readbyqxmd.com/read/28634646/the-role-of-robotics-in-the-invasive-management-of-bladder-cancer
#4
REVIEW
Pramit Khetrapal, Wei Shen Tan, Benjamin Lamb, Melanie Tan, Hilary Baker, James Thompson, Ashwin Sridhar, John D Kelly, Tim Briggs
Robot-assisted radical cystectomy (RARC) has been adopted widely in many centres, owed largely to the success of robot-assisted laparoscopic prostatectomy (RALP). It aims to replicate the oncological outcomes of open radical cystectomy (ORC), while providing a shorter recovery period. Despite this, previous RCTs have failed to show a benefit for RARC over ORC. These trials have compared extracorporeal RARC (eRARC) with ORC, which requires a further incision to mobilise the bowel for urinary reconstruction with an open technique...
August 2017: Current Urology Reports
https://www.readbyqxmd.com/read/28469297/advances-in-surgical-management-of-muscle-invasive-bladder-cancer
#5
REVIEW
Janet Baack Kukreja, Jay B Shah
INTRODUCTION: Bladder cancer remains a disease of the elderly with relatively few advances that have improved survival over the last 20 years. Radical cystectomy (RC) has long remained the principal treatment for muscle-invasive bladder cancer (MIBC). METHODS: A literature search of PubMed was performed. The content was reviewed for continuity with the topic of surgical advances in MIBC. Articles and society guidelines were included in this review. RESULTS: Despite the associated morbidity, even in the elderly, RC is still a reasonable option...
April 2017: Indian Journal of Urology: IJU: Journal of the Urological Society of India
https://www.readbyqxmd.com/read/28462518/alvimopan-for-recovery-of-bowel-function-after-radical-cystectomy
#6
REVIEW
Shahnaz Sultan, Bernadette Coles, Philipp Dahm
BACKGROUND: Alvimopan is used in abdominal surgery to reduce postoperative ileus in patients undergoing small bowel resections with primary anastomosis. The role and efficacy of alvimopan in patients undergoing radical cystectomy with urinary diversion is not well understood. OBJECTIVES: To assess the effects of alvimopan in the context of enhanced recovery pathways compared to enhanced recovery pathways alone for perioperative bowel dysfunction in patients undergoing radical cystectomy...
May 2, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28342928/does-implementing-an-enhanced-recovery-after-surgery-protocol-increase-hospital-charges-comparisons-from-a-radical-cystectomy-program-at-a-specialty-cancer-center
#7
Juan Chipollini, Dominic H Tang, Karim Hussein, Sephalie Y Patel, Rosemarie E Garcia-Getting, Julio M Pow-Sang, Scott M Gilbert, Wade J Sexton, Philippe E Spiess, Michael A Poch
OBJECTIVE: To compare perioperative charges induced at the initial phase of a standardized enhanced recovery after surgery (ERAS) program from a tertiary referral center. METHODS: A multidisciplinary ERAS protocol was implemented in our department on July 2015. During the subsequent year, all patients were treated according to this protocol (ERAS group). The patients were compared in terms of real in-hospital charges per surgical episode with a control group consisting of consecutive patients before the start of ERAS...
March 23, 2017: Urology
https://www.readbyqxmd.com/read/28256704/a-comprehensive-guide-to-perioperative-management-and-operative-technique-for-robotic-cystectomy-with-intracorporeal-urinary-diversion
#8
Wei Shen Tan, Benjamin W Lamb, Ashwin Sridhar, Timothy P Briggs, John D Kelly
Robotic-assisted radical cystectomy (RARC) represents an evolution of open radical cystectomy (ORC) with the aim of reducing patient morbidity and improving return to normal function, whilst maintaining oncological equivalence. RARC is gaining popularity, especially in high-volume centres, although there remains a lack of level 1 evidence to demonstrate any superiority of RARC over ORC. All previously reported studies that randomised ORC and RARC have utilised a technique for RARC requiring a conversion to open surgery for urinary diversion...
February 27, 2017: Urologia
https://www.readbyqxmd.com/read/28214097/impact-of-an-enhanced-recovery-after-surgery-programme-in-radical-cystectomy-a-cohort-comparative-study
#9
R Casans-Francés, A T Roberto-Alcácer, A C García-Lecina, M L Ferrer-Ferrer, J Subirá-Ríos, J Guillén-Antón
OBJECTIVE: To evaluate the results of the implementation of an enhanced recovery program (ERAS) for open approach radical cystectomy compared to the historical cohort of the same hospital. MATERIAL AND METHODS: A retrospective analysis of 138 consecutive patients who underwent radical cystectomy with Bricker or Studer ileal derivation (97 historical vs. 41 ERAS). Overall complication rate, Clavien-Dindo stage>2 complications, mortality, hospital and critical care length of stay and readmission rates, as well as need for reoperation, nasogastric intubation, transfusion or parenteral nutrition were compared...
June 2017: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/28149935/readmission-rate-and-causes-at-90-day-after-radical-cystectomy-in-patients-on-early-recovery-after-surgery-protocol
#10
Emanuela Altobelli, Maurizio Buscarini, Harcharan S Gill, Eila C Skinner
Background: Radical cystectomy (RC) is associated with high risk of early and late perioperative complications, and readmissions. The Enhanced Recovery After Surgery (ERAS) protocol has been applied to RC showing decreased hospital stay without increased morbidity. Objective: To evaluate the specific causes of hospital readmissions in RC patients treated before and after adoption of an ERAS protocol at our institution. Methods: We retrospectively evaluated the outcome of 207 RC patients on ERAS protocol at the Stanford University Hospital from January 2012 to December 2014...
January 27, 2017: Bladder Cancer
https://www.readbyqxmd.com/read/28000990/quality-improvement-in-cystectomy-care-with-enhanced-recovery-quiccer-study
#11
EDITORIAL
George N Thalmann
No abstract text is available yet for this article.
January 2017: BJU International
https://www.readbyqxmd.com/read/27862828/introduction-of-robot-assisted-radical-cystectomy-within-an-established-enhanced-recovery-programme
#12
Catherine Miller, Nicholas J Campain, Rachel Dbeis, Mark Daugherty, Nicholas Batchelor, Elizabeth Waine, John S McGrath
OBJECTIVES: To describe the implementation phase of a robot-assisted radical cystectomy (RARC) programme including side-effect profiles and impact on length of stay (LOS). PATIENTS AND METHODS: In all, 114 consecutive patients (82% male) underwent RARC and urinary diversion between April 2013 and December 2015 [ileal conduit (97 patients) and orthotopic neobladder (17)]. Surgery was performed by two surgeons within a designated regional cancer centre. No exclusion criteria were applied...
August 2017: BJU International
https://www.readbyqxmd.com/read/27734131/90-day-complication-rate-in-patients-undergoing-radical-cystectomy-with-enhanced-recovery-protocol-a-prospective-cohort-study
#13
Hooman Djaladat, Behrod Katebian, Soroush T Bazargani, Gus Miranda, Jie Cai, Anne K Schuckman, Siamak Daneshmand
PURPOSE: To report 90-day complication rates following radical cystectomy (RC) with enhanced recovery after surgery (ERAS) protocol. METHODS: All consecutive patients who underwent open RC with ERAS protocol from 2012 to 2014 were included. The protocol includes no bowel preparation or NGT, early feeding, predominantly non-narcotic pain management and μ-opioid antagonists. Non-consenting and lost to follow-up patients were excluded. All patients were closely followed up, and 90-day complication (Clavien-Dindo grading), readmission and emergency room (ER) visits were prospectively recorded...
October 12, 2016: World Journal of Urology
https://www.readbyqxmd.com/read/27416541/impact-of-a-potassium-enriched-chloride-depleted-5-glucose-solution-on-gastrointestinal-function-after-major-abdominopelvic-surgery-results-of-a-randomized-controlled-trial
#14
RANDOMIZED CONTROLLED TRIAL
Lukas M Löffel, Fiona C Burkhard, Jukka Takala, Patrick Y Wuethrich
BACKGROUND: Gastrointestinal (GI) complications often delay recovery after radical cystectomy with urinary diversion. The authors investigated if perioperative administration of a potassium-enriched, chloride-depleted 5% glucose solution (G5K) accelerates recovery of GI function. METHODS: This randomized, parallel-group, single-center double-blind trial included 44 consecutive patients undergoing radical cystectomy and pelvic lymph node dissection with urinary diversion...
October 2016: Anesthesiology
https://www.readbyqxmd.com/read/27402372/a-prospective-randomized-trial-of-the-effects-of-early-enteral-feeding-after-radical-cystectomy
#15
Christopher M Deibert, Mark V Silva, Arindam RoyChoudhury, James M McKiernan, Douglas S Scherr, David Seres, Mitchell C Benson
OBJECTIVE: To investigate the role of early feeding on recovery after radical cystectomy and urinary diversion. Enhanced recovery protocols have helped to standardize postoperative recovery. This is the first study to directly review the impact of early feeding on recovery in a randomized multi-institutional protocol. METHODS: From 2011 to 2014, patients at 2 large hospitals were randomized after radical cystectomy to receive access to liquids and then a regular diet on postoperative days 1 and 2 or conventional care with introduction of a liquid diet after return of bowel activity, typically days 3-5...
July 8, 2016: Urology
https://www.readbyqxmd.com/read/27349613/moving-towards-widespread-implementation-of-enhanced-recovery-protocols-for-radical-cystectomy
#16
EDITORIAL
Philip J Cheng, Mark A Preston
No abstract text is available yet for this article.
December 2016: European Urology
https://www.readbyqxmd.com/read/27297680/enhanced-recovery-pathways-versus-standard-care-after-cystectomy-a-meta-analysis-of-the-effect-on-perioperative-outcomes
#17
REVIEW
Mark D Tyson, Sam S Chang
CONTEXT: Enhanced recovery after surgery (ERAS) protocols aim to improve surgical outcomes by reducing variation in perioperative best practices. However, among published studies, results show a striking variation in the effect of ERAS pathways on perioperative outcomes after cystectomy. OBJECTIVE: To perform a systematic review of the literature and a meta-analysis comparing the effectiveness of ERAS versus standard care on perioperative outcomes after cystectomy...
December 2016: European Urology
https://www.readbyqxmd.com/read/27234997/enhanced-recovery-after-robot-assisted-radical-cystectomy-eau-robotic-urology-section-scientific-working-group-consensus-view
#18
REVIEW
Justin W Collins, Hiten Patel, Christofer Adding, Magnus Annerstedt, Prokar Dasgupta, Shamim M Khan, Walter Artibani, Richard Gaston, Thierry Piechaud, James W Catto, Anthony Koupparis, Edward Rowe, Matthew Perry, Rami Issa, John McGrath, John Kelly, Martin Schumacher, Carl Wijburg, Abdullah E Canda, Meviana D Balbay, Karel Decaestecker, Christian Schwentner, Arnulf Stenzl, Sebastian Edeling, Sasa Pokupić, Michael Stockle, Stefan Siemer, Rafael Sanchez-Salas, Xavier Cathelineau, Robin Weston, Mark Johnson, Fredrik D'Hondt, Alexander Mottrie, Abolfazl Hosseini, Peter N Wiklund
CONTEXT: Radical cystectomy (RC) is associated with frequent morbidity and prolonged length of stay (LOS) irrespective of surgical approach. Increasing evidence from colorectal surgery indicates that minimally invasive surgery and enhanced recovery programmes (ERPs) can reduce surgical morbidity and LOS. ERPs are now recognised as an important component of surgical management for RC. However, there is comparatively little evidence for ERPs after robot-assisted radical cystectomy (RARC)...
October 2016: European Urology
https://www.readbyqxmd.com/read/27164287/the-future-of-enhanced-recovery-for-radical-cystectomy-current-evidence-barriers-to-adoption-and-the-next-steps
#19
Bernard J Danna, Erika L Wood, Janet E Baack Kukreja, Jay B Shah
Radical cystectomy (RC) is a complex procedure that can involve long postoperative hospital stays and complicated, burdensome recoveries. Enhanced recovery after surgery is a broad term encompassing an overall approach to perioperative management of postsurgical patients and is becoming more widely accepted for cystectomy patients. This review examines the current evidence for using enhanced recovery protocols for RC as well as current rates of adoption of enhanced recovery among urologists performing RC. We also discuss the next steps for overcoming barriers to the widespread implementation of enhanced recovery for RC...
October 2016: Urology
https://www.readbyqxmd.com/read/27128851/quality-improvement-in-cystectomy-care-with-enhanced-recovery-quiccer-study
#20
Janet E Baack Kukreja, Maureen Kiernan, Bethany Schempp, Aisha Siebert, Adriana Hontar, Benjamin Nelson, James Dolan, Katia Noyes, Ann Dozier, Ahmed Ghazi, Hani H Rashid, Guan Wu, Edward M Messing
OBJECTIVES: To determine if patients managed with a cystectomy enhanced recovery pathway (CERP) have improved quality of care after radical cystectomy (RC), as defined by a decrease in length of hospital stay (LOS) without an increase in complications or readmissions compared with those not managed with CERP. SUBJECTS AND METHODS: The Quality Improvement in Cystectomy Care with Enhanced Recovery (QUICCER) study was a non-randomized quasi-experimental study. Data were collected between June 2011 and April 2015...
January 2017: BJU International
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