Objective: Different fast track programs for patients undergoing radicalcystectomy (RC) can be found in the current literature. The aim of this work was to develop a new enhanced recovery protocol (ERP). Patients and Methods: The ERP was designed after a structured literature review focusing on reduced bowelpreparation, standardized feeding, postoperative nausea, vomiting and paincontrol. In order to test the ERP, a pilot observational prospective cohort studywas planned, enrolling all patients consecutively undergoing RC and VescicaIleale Padovana (VIP) neobladder. These patients were compared with a matchedgroup of subjects who had undergone RC and VIP neobladder before implementationof the ERP. To achieve good comparability, a propensity score-matching wasperformed. The primary aim was to assess the ERP's feasibility; the secondaryoutcome measures were early morbidity and mortality. Results and Limitations:After an exhaustive literature search and a multidisciplinary consultation, anERP was designed. Nine consecutive patients participated in the pilot study andwere compared to 13 patients treated before implementation of the ERP. We did notfind any statistically significant difference in terms of mortality rate (nonedied peri- or postoperatively in both groups). The complication rate, accordingto the modified Clavien classification, was significantly lower in the ERP group (22.22 vs. 84.61%, p < 0.004). The major limitations are the low number ofpatients enrolled to test the protocol and the lack of randomization for thecomparative evaluations. Conclusion: The introduction of our ERP was proven to befeasible in the management of patients undergoing RC and intestinal urinarydiversion with VIP neobladder. The postoperative course was enhanced by asignificant reduction in both nasogastric tube insertion and parenteral nutritionsupport, with early postoperative feeding. All these findings were associatedwith no deleterious effect on morbidity or mortality, indeed there was a reduced occurrence of postoperative complication rates

Fast Track Surgery to Reduce Short-Term Complications following Radical Cystectomy and Intestinal Urinary Diversion with Vescica Ileale Padovana Neobladder: Proposal for a Tailored Enhanced Recovery Protocol and Preliminary Report from a Pilot Study.

CERRUTO, Maria Angela;D'ELIA, Carolina;ARTIBANI, Walter
2014

Abstract

Objective: Different fast track programs for patients undergoing radicalcystectomy (RC) can be found in the current literature. The aim of this work was to develop a new enhanced recovery protocol (ERP). Patients and Methods: The ERP was designed after a structured literature review focusing on reduced bowelpreparation, standardized feeding, postoperative nausea, vomiting and paincontrol. In order to test the ERP, a pilot observational prospective cohort studywas planned, enrolling all patients consecutively undergoing RC and VescicaIleale Padovana (VIP) neobladder. These patients were compared with a matchedgroup of subjects who had undergone RC and VIP neobladder before implementationof the ERP. To achieve good comparability, a propensity score-matching wasperformed. The primary aim was to assess the ERP's feasibility; the secondaryoutcome measures were early morbidity and mortality. Results and Limitations:After an exhaustive literature search and a multidisciplinary consultation, anERP was designed. Nine consecutive patients participated in the pilot study andwere compared to 13 patients treated before implementation of the ERP. We did notfind any statistically significant difference in terms of mortality rate (nonedied peri- or postoperatively in both groups). The complication rate, accordingto the modified Clavien classification, was significantly lower in the ERP group (22.22 vs. 84.61%, p < 0.004). The major limitations are the low number ofpatients enrolled to test the protocol and the lack of randomization for thecomparative evaluations. Conclusion: The introduction of our ERP was proven to befeasible in the management of patients undergoing RC and intestinal urinarydiversion with VIP neobladder. The postoperative course was enhanced by asignificant reduction in both nasogastric tube insertion and parenteral nutritionsupport, with early postoperative feeding. All these findings were associatedwith no deleterious effect on morbidity or mortality, indeed there was a reduced occurrence of postoperative complication rates
radical cystectomy; protocol; complications
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/627285
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