Ahmad Zulfan Hendri
* Corresponding Author Division of Urology, Department of Surgery, Faculty of Medicine, Universitas
Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia. Indonesia
Muhammad Mauny Puteh Division of Urology, Department of Surgery, Faculty of Medicine, Universitas
Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia.
Said Alfin Khalilullah Division of Urology, Department of Surgery, Faculty of Medicine, Universitas
Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia.
Andy Zulfiqqar Division of Urology, Department of Surgery, Faculty of Medicine, Universitas
Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia. Indonesia
Ahmad Zulfan Hendri(1*), Muhammad Mauny Puteh(2), Said Alfin Khalilullah(3), Andy Zulfiqqar(4)
(1) Division of Urology, Department of Surgery, Faculty of Medicine, Universitas
Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia. (2) Division of Urology, Department of Surgery, Faculty of Medicine, Universitas
Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia. (3) Division of Urology, Department of Surgery, Faculty of Medicine, Universitas
Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia. (4) Division of Urology, Department of Surgery, Faculty of Medicine, Universitas
Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia. (*) Corresponding Author
Abstract
Radical cystectomy (RC) remains associated with a greater number of postsurgical complications than any urological procedure. Enhanced recovery after surgery (ERAS) protocol is a multimodal perioperative care pathway designed to achieve early postsurgical recovery. We evaluated the perioperative outcome of post-RC patients, comparing the effectiveness of ERAS to conventional recovery protocols. We identified 37 patients who underwent RC for bladder cancer from 2016 to 2018. The characteristics, complication rate and clinical outcomes were evaluated in these groups of patients. In this study, the mortality was 8.1%, and the complications were 37.8%. The most frequent complications were anastomotic leakage (16.2%), wound dehiscence (13.5%), infections/sepsis (8.1%), and paralytic ileus (8.1%). The ERAS protocol significantly reduced operative time (p=0.001; OR=216; CI95%: 12.0-3855.2) and reduced overall complications (p=0.04; OR= 0.14 CI95%: 0.016-1.132). Extensive complications and mortality develop following the RC procedure. Meanwhile, refinement in perioperative care has been reducing the rate of serious complications. The ERAS protocol distinctly reduces the post-RC complication rate.
Daneshmand S, Ahmadi H, Schuckman AK, Mitra AP, Cai J, Miranda G, et all. Enhanced recovery protokol after radical cystectomy for bladder cancer. J Urol 2014; 192:50-6. https://doi.org/10.1016/j.juro.2014.01.097
Patel HRH, CerantolaY, Valerio M, Persson B, Jichlinski P, Ljungqvist O, et all. Enhanced recovery after surgery: Are we ready, and can we afford not to implement these pathways for patients undergoing radical cystectomy? European urology 2014; 65:263-6. https://doi.org/10.1016/j.eururo.2013.10.011
Melnyk M, Casey RG, Black P, Koupparis AP. Enhanced recovery after surgery (ERAS) protocols: Time to change practice? Canadian Urological Association journal = Journal de L'Association des urologues du Canada. 2011; 5:342-8. https://doi.org/10.5489/cuaj.11002
Nabhani J, Ahmadi H, Schuckman AK, Cai J, Miranda G, Djaladat H, et all. Cost analysis of the enhanced recovery after surgery protokol in patients undergoing radical cystectomy for bladder cancer. European Urology Focus 2015; 2(1):92-6. https://doi.org/10.1016/j.euf.2015.06.009
Azhar RA, BochnerB, Catto J, Goh AC, Kelly J, Patel HD, et al. Enhanced recovery after urological surgery: A contemporary systematic review of outcomes, key elements, and research needs. Eur Urol 2016; 70(1):176-78. https://doi.org/10.1016/j.eururo.2016.02.051
Danna BJ, Wood EL, Kukreja JEB, Shah JB. The future of enhanced recovery for radical cystectomy: Current evidence, barriers to adoption, and the next steps. Urology 2016; 96:62-8. https://doi.org/10.1016/j.urology.2016.04.038
Tyson MD, Chang SS. Enhanced recovery pathway versus standard care after cystectomy: A meta-analysis of the effect on perioperative outcomes. Eur Urol 2016; 70(6):995-1003. https://doi.org/10.1016/j.eururo.2016.05.031
Cerantola Y, Valerio M, Persson B, Jichlinski P, Ljungqvist O, Hubner M, et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS?) society recommendations. Clin Nutr 2013; 32(6):879-87. https://doi.org/10.1016/j.clnu.2013.09.014
McGrath J. Adopting enhanced recovery programmes in radical cystectomy: can we afford not to? Eur Urol Focus 2016 2(1):97-8. https://doi.org/10.1016/j.euf.2015.08.003
Preston MA, Lerner SP, Kibel AS. New trends in the surgical management of invasive bladder cancer. Hematol Oncol Clin N Am 2015; 29(2):253-69. https://doi.org/10.1016/j.hoc.2014.10.010
Karl A, Buchner A, Becker A, Staehler M, Seitz M, Khoder W, et al. A new concept for early recovery after surgery for patients undergoing radical cystectomy for bladder cancer: Results of a prospective randomized study. J Urol 2014; 191(2):335-40. https://doi.org/10.1016/j.juro.2013.08.019
Devane LA, Proud D, O'Connell PR, Panis Y. A European survey of bowel preparation in colorectal surgery. Colorectal Dis 2017; 19(11):402-6. https://doi.org/10.1111/codi.13905
Bucher P, Mermillod B, Gervaz P, Morel P. Mechanical bowel preparation for elective colorectal surgery: a meta-analysis. Arch Surg 2004; 139(12):1359-64. https://doi.org/10.1001/archsurg.139.12.1359
Liu B, Domes T, Jana K. Evaluation of an enhanced recovery protocol on patients having radical cystectomy for bladder cancer. Can Urol Assoc J 2018; 12(12):421-6. https://doi.org/10.5489/cuaj.5273
Wayan Y, Ayu PD, Gde OAA, Wayan N, Widyadharma IPE. Pathological profile, early complications, functional and oncological outcome after radical cystectomy - ileal conduit for bladder cancer patients in Sanglah General Hospital between January 2013 and December 2016. J Med Sci 2018; 6(9):1647-51. https://doi.org/10.3889/oamjms.2018.384