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ERAS cystectomy

Robert Rosenblatt, Markus Johansson, Farhood Alamdari, Alexander Sidiki, Benny Holmström, Johan Hansson, Janos Vasko, Per Marits, Susanne Gabrielsson, Katrine Riklund, Ola Winqvist, Amir Sherif
PURPOSE: To determine whether sentinel node detection (SNd) in muscle-invasive urothelial bladder cancer (MIBC) can be performed in patients undergoing neoadjuvant chemotherapy (NAC) and determine whether SNd is feasible in all pT stages, including pT0. BACKGROUND: Previous published series of SNd in MIBC have not included patients undergoing NAC, and systematic reports of pT0 patients w/wo NAC were absent. Translational immunological tumor research on MIBC focusing on SNd, in the era of NAC, requires technical feasibility...
October 13, 2016: World Journal of Urology
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
Vignesh T Packiam, Vijay A Agrawal, Joseph J Pariser, Andrew J Cohen, Charles U Nottingham, Shane M Pearce, Norm D Smith, Gary D Steinberg
PURPOSE: Alvimopan has decreased ileus and need for nasogastric tube (NGT) after radical cystectomy (RC). However, the natural history of ileus versus intestinal obstruction in patients receiving alvimopan is not well defined. We sought to examine the implications of NGT placement before and after the introduction of alvimopan for RC patients. METHODS: Retrospective review identified 278 and 293 consecutive patients who underwent RC before and after instituting alvimopan between June 2009 and May 2014...
July 30, 2016: World Journal of Urology
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...
June 10, 2016: European Urology
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
Hooman Djaladat, Siamak Daneshmand
Gastrointestinal (GI) complications are among the most common complications following radical cystectomy and urinary diversion. The most common is postoperative ileus, although its precise pathophysiology is not completely understood. Enhanced recovery after surgery (ERAS) protocols include evidence-based steps to optimize postoperative recovery and shorten hospital stay, mainly through expedited GI function recovery. They include avoiding bowel preparation and postoperative nasogastric tube, early feeding, non-narcotic pain management, and the use of cholinergic and mu-receptor opioid antagonists...
July 2016: Current Urology Reports
Raed A Azhar, Bernard Bochner, James Catto, Alvin C Goh, John Kelly, Hiten D Patel, Raj S Pruthi, George N Thalmann, Mihir Desai
CONTEXT: Enhanced Recovery after Surgery (ERAS) programs are multimodal care pathways that aim to decrease intra-operative blood loss, decrease postoperative complications, and reduce recovery times. OBJECTIVE: To overview the use and key elements of ERAS pathways, and define needs for future clinical trials. EVIDENCE ACQUISITION: A comprehensive systematic MEDLINE search was performed for English language reports published before May 2015 using the terms "postoperative period," "postoperative care," "enhanced recovery after surgery," "enhanced recovery," "accelerated recovery," "fast track recovery," "recovery program," "recovery pathway", "ERAS," and "urology" or "cystectomy" or "urologic surgery...
July 2016: European Urology
Vivekanand Kattimani, Krishna Prasad Lingamaneni, Pandi Srinivas Chakravarthi, T S Sampath Kumar, Arjunan Siddharthan
BACKGROUND: Defects of maxillofacial skeleton lead to personal (functional and aesthetic), social and behavioral problems; which make the person to isolate from the main stream of society. So, bone regeneration is the need for proper structure, function, and aesthetics following cyst enucleation, trauma, and tumor ablative surgery; which helps for overall health of the individual. AIM AND OBJECTIVES: The preliminary study is planned to evaluate and compare the efficacy of eggshell-derived hydroxyapatite (EHA) and synthetic hydroxyapatite (SHA) following cystectomy...
January 2016: Journal of Craniofacial Surgery
Khurram M Siddiqui, Jonathan I Izawa
In the era of managed healthcare, the measuring and reporting of surgical outcomes is a universal mandate. The outcomes should be monitored and reported in a timely manner. Methods for measuring surgical outcomes should be continuous, free of bias and accommodate variations in patient factors. The traditional methods of surgical audits are periodic, resource-intensive and have a potential for bias. These audits are typically annual and therefore there is a long time lag before any effective remedial action could be taken...
June 2015: Arab Journal of Urology
Brian J Minnillo, Matthew J Maurice, Nicholas Schiltz, Aiswarya C Pillai, Siran M Koroukian, Firouz Daneshgari, Sim P Kim, Robert Abouassaly
INTRODUCTION: We sought to determine the patient and provider-related factors associated with readmission after radical cystectomy (RC) for bladder cancer. In this era of healthcare reform, hospital performance measures, such as readmission, are beginning to affect provider reimbursement. Given its high readmission rate, RC could be a target for quality improvement. METHODS: We reviewed bladder cancer patients who underwent RC in California's State Inpatient Database (2005-2009) of the Healthcare Cost and Utilization Project...
July 2015: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
Domenic Di Rollo, Aza Mohammed, Alexander Rawlinson, Jayne Douglas-Moore, John Beatty
INTRODUCTION: The principles of enhanced recovery after surgery (ERAS) protocols have been developed to optimize care and facilitate recovery after major surgery. The purpose of this systematic review is to present an up-to-date assessment of the perioperative cares in complex urological surgery from the available evidence and ERAS group recommendations. MATERIALS AND METHODS: Systematic searches of PubMed, Embase, Cochrane library and conference abstracts and bibliographies databases...
June 2015: Canadian Journal of Urology
Maria C Mir, Homayoun Zargar, Damien M Bolton, Declan G Murphy, Nathan Lawrentschuk
BACKGROUND: Radical cystectomy (RC) remains a morbid procedure. The use of Enhanced Recovery After Surgery (ERAS) pathways has proven to reduce care time and post-operative complications after colorectal surgery. There is a high potential for reducing morbidity associated with RC by utilizing ERAS in this setting. The purpose of this review is to examine the current evidence for ERAS in preoperative, intra-operative and post-operative setting of care for RC patients and to propose ERAS evidence-based protocol for patients undergoing RC in the Australian and New Zealand environment...
July 2015: ANZ Journal of Surgery
Beata Persson, Malcolm Carringer, Ove Andrén, Swen-Olof Andersson, Jessica Carlsson, Olle Ljungqvist
OBJECTIVE: This article describes the authors' experiences with the implementation of the Enhanced Recovery After Surgery (ERAS) protocol for open radical cystectomy (ORC). Adherence to the ERAS cystectomy protocol was assessed; secondary outcome measures were impact on perioperative complication rate (Clavien-Dindo classification), time to first defecation, postoperative length of stay and hospital readmission rate. MATERIALS AND METHODS: This retrospective feasibility study compared outcomes with patients in a historical control group...
2015: Scandinavian Journal of Urology
Hiroshi Kitamura, Yoshiyuki Kakehi
Most T1 bladder cancers are high grade and have the potential to progress to muscle invasion and extravesical dissemination. Many studies reported that ∼50% of patients displayed residual tumors when a second transurethral resection was performed 2-6 weeks after the initial resection for patients who were diagnosed with T1 bladder cancer. Furthermore, muscle-invasive disease was detected by the second transurethral resection in 10-25% of those patients. Therefore, a second transurethral resection is strongly recommended for patients newly diagnosed with high-grade T1 bladder cancer in various guidelines...
April 2015: Japanese Journal of Clinical Oncology
Giorgio Gandaglia, Briony Varda, Akshay Sood, Daniel Pucheril, Ramdev Konijeti, Jesse D Sammon, Shyam Sukumar, Mani Menon, Maxine Sun, Steven L Chang, Francesco Montorsi, Adam S Kibel, Quoc-Dien Trinh
INTRODUCTION: We report the contemporary outcomes of radical cystectomy (RC) in patients with bladder cancer using a national, prospective perioperative database specifically developed to assess the quality of surgical care. METHODS: The National Surgical Quality Improvement Program (NSQIP) database was queried from 2006 to 2011 for RC. Data on postoperative complications, operative time, length of stay, blood transfusions, readmission, and mortality within 30 days from surgery were abstracted...
September 2014: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
Shaista Hafeez, Robert Huddart
Radical treatment remains underutilized for those with muscle-invasive bladder cancer. Radical radiotherapy, in particular, continues to be perceived by many as reserved only for patients unfit for cystectomy. However, with concurrent use of radiosensitizers, radiotherapy can achieve excellent local control and survival comparable to modern surgical series, thus presenting a real alternative to surgery. The possibility of further enhancing patient outcome is likely to come from both advances in radiotherapy treatment delivery and appropriate candidate selection...
December 2014: Expert Review of Anticancer Therapy
Kyo Chul Koo, Young Eun Yoon, Byung Ha Chung, Sung Joon Hong, Koon Ho Rha
PURPOSE: Postoperative ileus (POI) is common following bowel resection for radical cystectomy with ileal conduit (RCIC). We investigated perioperative factors associated with prolonged POI following RCIC, with specific focus on opioid-based analgesic dosage. MATERIALS AND METHODS: From March 2007 to January 2013, 78 open RCICs and 26 robot-assisted RCICs performed for bladder carcinoma were identified with adjustment for age, gender, American Society of Anesthesiologists grade, and body mass index (BMI)...
September 2014: Yonsei Medical Journal
Toru Sugihara, Hideo Yasunaga, Hiromasa Horiguchi, Kiyohide Fushimi, Jarrod E Dalton, Jesse Schold, Michael W Kattan, Yukio Homma
OBJECTIVES: To elucidate the differences in clinical practice between the USA and Japan in major types of uro-oncological surgery by a head-to-head comparison of national databases in the two countries. METHODS: We compared variations in surgical modality, length of stay, total charges, caseload centralization, transfusion incidence, and in-hospital mortality between the two countries for four major types of uro-oncological surgery (radical prostatectomy, radical cystectomy, nephrectomy and nephroureterectomy) in 2011...
November 2014: International Journal of Urology: Official Journal of the Japanese Urological Association
Olivier M'Baya, Yannis Vlamopoulos, Martin Hubner, Catherine Blanc, Patrice Jichlinski, Yannick Cerantola
Enhanced Recovery After Surgery (ERAS) is a multimodal concept combining pre, intra and postoperative evidence-based care elements to reduce surgical stress. ERAS pathways have been shown to significantly reduce morbidity, length of hospital stay and total costs when applied to colorectal surgery. It is therefore considered standard of care in this specialty. There can be no doubt that ERAS principles can be applied also in other major surgeries. However, uncritical application of the guidelines issued from colonic procedures seems inappropriate as the surgical procedures in pelvic cancer surgery differ considerably...
December 4, 2013: Revue Médicale Suisse
Yannick Cerantola, Massimo Valerio, Beata Persson, Patrice Jichlinski, Olle Ljungqvist, Martin Hubner, Wassim Kassouf, Stig Muller, Gabriele Baldini, Francesco Carli, Torvind Naesheimh, Lars Ytrebo, Arthur Revhaug, Kristoffer Lassen, Tore Knutsen, Erling Aarsether, Peter Wiklund, Hitendra R H Patel
PURPOSE: Enhanced recovery after surgery (ERAS) pathways have significantly reduced complications and length of hospital stay after colorectal procedures. This multimodal concept could probably be partially applied to major urological surgery. OBJECTIVES: The primary objective was to systematically assess the evidence of ERAS single items and protocols applied to cystectomy patients. The secondary objective was to address a grade of recommendation to each item, based on the evidence and, if lacking, on consensus opinion from our ERAS Society working group...
December 2013: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
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