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• W1999472020 abstract "No AccessJournal of UrologyAdult Urology1 Feb 2014A New Concept for Early Recovery after Surgery for Patients Undergoing Radical Cystectomy for Bladder Cancer: Results of a Prospective Randomized Study A. Karl, A. Buchner, A. Becker, M. Staehler, M. Seitz, W. Khoder, B. Schneevoigt, E. Weninger, P. Rittler, T. Grimm, C. Gratzke, and C. Stief A. KarlA. Karl Department of Urology, Ludwig-Maximilians-University, Munich, Germany More articles by this author , A. BuchnerA. Buchner Department of Urology, Ludwig-Maximilians-University, Munich, Germany More articles by this author , A. BeckerA. Becker Department of Urology, Ludwig-Maximilians-University, Munich, Germany More articles by this author , M. StaehlerM. Staehler Department of Urology, Ludwig-Maximilians-University, Munich, Germany More articles by this author , M. SeitzM. Seitz Department of Urology, Ludwig-Maximilians-University, Munich, Germany More articles by this author , W. KhoderW. Khoder Department of Urology, Ludwig-Maximilians-University, Munich, Germany More articles by this author , B. SchneevoigtB. Schneevoigt Department of Urology, Ludwig-Maximilians-University, Munich, Germany More articles by this author , E. WeningerE. Weninger Department of Anesthesiology, Ludwig-Maximilians-University, Munich, Germany More articles by this author , P. RittlerP. Rittler Department of Abdominal Surgery, Ludwig-Maximilians-University, Munich, Germany More articles by this author , T. GrimmT. Grimm Department of Urology, Ludwig-Maximilians-University, Munich, Germany More articles by this author , C. GratzkeC. Gratzke Department of Urology, Ludwig-Maximilians-University, Munich, Germany More articles by this author , and C. StiefC. Stief Department of Urology, Ludwig-Maximilians-University, Munich, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.08.019AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Early recovery after surgery concepts have gained wide acceptance in various surgical specialties. However, limited data are available for radical cystectomy. A new early recovery after surgery concept was compared to a more conservative regimen in patients undergoing radical cystectomy for bladder cancer. Materials and Methods: A total of 101 consecutive patients were prospectively randomized to early recovery after surgery (62) or a conservative regimen (39) (intended randomization ratio was 2 early recovery after surgery-to-1 conservative regimen). Primary end points were differences in quality of life, and secondary end points included postoperative morbidity, demand for analgesics, time spent in the intermediate care unit, mobility and number of gastrointestinal events during hospital stay. Results: Quality of life parameters, as measured by the EORTC (European Organization for the Research and Treatment of Cancer) Quality of Life questionnaire QLQ-30 did not change significantly between postoperative days 3 and 7 and at discharge from hospital in the conservative regimen group, whereas a significant improvement was observed in the early recovery after surgery group. Postoperative morbidity was lower in the early recovery after surgery group in terms of wound healing disorders (p = 0.006), fever (p = 0.004) and thrombosis (p = 0.027). The demand for analgesics was significantly lower in the early recovery after surgery group. The amount of food consumed in relation to the amount of food offered was significantly higher for the early recovery after surgery group as early as day 3 (p = 0.02). Time spent in the intermediate care unit was significantly shorter for the early recovery after surgery group (p <0.001). There were no significant differences between the groups with respect to gastrointestinal events. The main limitations of this study were the lack of long-term data as well as the single center approach. Conclusions: Early recovery after surgery of patients who underwent radical cystectomy appears to have significant benefits compared to a conservative regimen in terms of postoperative morbidity, quality of life, use of analgesics and time spent in the intermediate care unit. References 1 : Multimodal strategies to improve surgical outcome. Am J Surg2002; 183: 630. Google Scholar 2 : Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev2005; 1: CD001544. Google Scholar 3 : Fast-track colorectal surgery. Lancet2008; 371: 791. Google Scholar 4 : A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg2007; 245: 867. Google Scholar 5 : Fast-track rehabilitation after robot-assisted laparoscopic cystectomy accelerates postoperative recovery. BJU Int2013; 112: E99. Google Scholar 6 : Fast-track surgery and technical nuances to reduce complications after radical cystectomy and intestinal urinary diversion with the modified Indiana pouch. Surg Oncol2012; 21: 191. Google Scholar 7 : Fast track program in patients undergoing radical cystectomy: results in 362 consecutive patients. J Am Coll Surg2010; 210: 93. Google Scholar 8 : Fast-track concepts in the perioperative management of patients undergoing radical cystectomy and urinary diversion: review of the literature and research results. Urologe A2009; 48: 137. Google Scholar 9 : Early enteral feeding versus “nil by mouth” after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ2001; 323: 773. Google Scholar 10 : Parenteral nutrition does not improve postoperative recovery from radical cystectomy: results of a prospective randomised trial. Eur Urol2013; 63: 475. Google Scholar 11 : Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA2005; 293: 715. Google Scholar 12 : The role of the anesthesiologist in fast-track surgery: from multimodal analgesia to perioperative medical care. Anesth Analg2007; 104: 1380. Google Scholar 13 : Prospective randomized controlled trial of robotic versus open radical cystectomy for bladder cancer: perioperative and pathologic results. Eur Urol2010; 57: 196. Google Scholar 14 : Attenuated modulation of brain activity accompanies emotion regulation deficits in alexithymia. Psychophysiology2012; 49: 651. Google Scholar 15 : Routine nasogastric tubes are not required following cystectomy with urinary diversion: a comparative analysis of 430 patients. J Urol2003; 170: 1888. Link, Google Scholar 16 : Conservative vs restrictive individualized goal-directed fluid replacement strategy in major abdominal surgery: a prospective randomized trial. Arch Surg2010; 145: 1193. Google Scholar 17 : Pre-operative intravenous fluid therapy with crystalloids or colloids on post-operative nausea & vomiting. Indian J Med Res2008; 127: 577. Google Scholar © 2014 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byWinters B, Wright J, Holt S, Dash A, Gore J and Schade G (2018) Health Related Quality of Life Following Radical Cystectomy: Comparative Analysis from the Medicare Health Outcomes SurveyJournal of Urology, VOL. 199, NO. 3, (669-675), Online publication date: 1-Mar-2018.Haid B, Karl A, Koen M, Mottl W, Haid A and Oswald J (2018) Enhanced Recovery after Surgery Protocol for Pediatric Urological Augmentation and Diversion Surgery Using Small BowelJournal of Urology, VOL. 200, NO. 5, (1100-1106), Online publication date: 1-Nov-2018.Kretschmer A, Grimm T, Buchner A, Grimm J, Grabbert M, Jokisch F, Schneevoigt B, Apfelbeck M, Schulz G, Bauer R, Stief C and Karl A (2018) Prognostic Features for Objectively Defined Urinary Continence after Radical Cystectomy and Ileal Orthotopic Neobladder in a Contemporary CohortJournal of Urology, VOL. 197, NO. 1, (210-215), Online publication date: 1-Jan-2017.Griebling T (2018) Re: Report of a Simplified Frailty Score Predictive of Short-Term Postoperative Morbidity and MortalityJournal of Urology, VOL. 196, NO. 3, (789-790), Online publication date: 1-Sep-2016.Steers W (2018) This Month in Adult UrologyJournal of Urology, VOL. 191, NO. 2, (281-282), Online publication date: 1-Feb-2014.Daneshmand S, Ahmadi H, Schuckman A, Mitra A, Cai J, Miranda G and Djaladat H (2018) Enhanced Recovery Protocol after Radical Cystectomy for Bladder CancerJournal of Urology, VOL. 192, NO. 1, (50-56), Online publication date: 1-Jul-2014. Volume 191Issue 2February 2014Page: 335-340 Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.Keywordsrehabilitationconvalescenceurinary bladder neoplasmscystectomyMetricsAuthor Information A. Karl Department of Urology, Ludwig-Maximilians-University, Munich, Germany More articles by this author A. Buchner Department of Urology, Ludwig-Maximilians-University, Munich, Germany More articles by this author A. Becker Department of Urology, Ludwig-Maximilians-University, Munich, Germany More articles by this author M. Staehler Department of Urology, Ludwig-Maximilians-University, Munich, Germany More articles by this author M. Seitz Department of Urology, Ludwig-Maximilians-University, Munich, Germany More articles by this author W. Khoder Department of Urology, Ludwig-Maximilians-University, Munich, Germany More articles by this author B. Schneevoigt Department of Urology, Ludwig-Maximilians-University, Munich, Germany More articles by this author E. Weninger Department of Anesthesiology, Ludwig-Maximilians-University, Munich, Germany More articles by this author P. Rittler Department of Abdominal Surgery, Ludwig-Maximilians-University, Munich, Germany More articles by this author T. Grimm Department of Urology, Ludwig-Maximilians-University, Munich, Germany More articles by this author C. Gratzke Department of Urology, Ludwig-Maximilians-University, Munich, Germany More articles by this author C. Stief Department of Urology, Ludwig-Maximilians-University, Munich, Germany More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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• W1999472020 title "A New Concept for Early Recovery after Surgery for Patients Undergoing Radical Cystectomy for Bladder Cancer: Results of a Prospective Randomized Study" @default.
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