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Enhanced Recovery After Surgery protocols for radical cystectomy surgery: review of current evidence and local protocols
Author(s) -
Mir Maria C.,
Zargar Homayoun,
Bolton Damien M.,
Murphy Declan G.,
Lawrentschuk Nathan
Publication year - 2015
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13043
Subject(s) - medicine , cystectomy , colorectal surgery , perioperative , intensive care medicine , ileus , protocol (science) , surgery , evidence based practice , bladder cancer , alternative medicine , pathology , cancer , abdominal surgery
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 N ew Z ealand environment. Preoperative Patient's medical optimization, avoidance of oral mechanical bowel preparation and emphasis on preoperative administration of high‐energy carbohydrate drinks from colorectal literature has led to inclusion of these strategies in the preoperative considerations of ERAS in RC . Intra‐operative Epidural analgesia has an integral role in reducing surgical stress response, improving analgesia and expediting functional recovery and should be included in ERAS RC protocols. Of relevance is 72 h maximum length of its duration. With regard to minimally invasive approach to RC , despite encouraging results from high‐volume centres, high‐level evidence in this field are lacking (ongoing clinical trials). Standardized anaesthetic protocols with particular emphasis on perioperative fluid management are essential components of ERAS protocols. Post‐operative Avoidance of routine nasogastric tube placement, early mobilization and multifaceted approach to optimization of gut function and elimination of post‐operative ileus are the cornerstones of post‐operative care in the setting of ERAS in RC patients.