Application of ERAS (Enhanced Recovery After Surgery) and laparoscopic surgery in the management of patients with bladder cancer.

OBJECTIVE: The enhanced recovery after surgery program (ERAS) has become the base of perioperative management in various surgical specialties. However, limited data are available for radical cystectomy.

METHODS: We have analyzed 124 patients undergoing radical cystectomy. For retrospective analysis, the patients were divided into two groups:Group A (n=72) included patients whose surgery was performed before the introduction of the ERAS protocol; and Group B (n=52) included patients who were treated following the items included in the ERAS protocol. The main objective was to assess the length of hospital stay and the permanence in intensive care units (ICU). Other variables were the use of intraoperative blood products, fluid-therapy and medical and surgical complications.

RESULTS: Hospital and ICU stay were significantly shorter (p〈0.001) in Group B for patients following the ERAS protocol, which led to reduce 7 hospitalization days and 25.7 hours of overall ICU stay. Regarding fluid replacement following the ERAS protocol, our study showed a statistically significant reduction in the total amount of fluid administered, both crystalloids and colloids, in Group B (p〈0.001). The need of blood transfusion was also lower in Group B with a statistically significant difference (p〈0.001). No statistical differences were observed regarding the incidence of surgical complications.

CONCLUSIONS: Introduction of ERAS protocol in radical cystectomy decreases the length of hospital stay, permanence in critical care units, and the need for fluidtherapy and blood product transfusion. However, more and larger studies are needed to prove the efficacy of ERAS for patients undergoing radical cystectomy.