392
EUROPEAN UROLOGY 66 (2014) 386–392
Re: A New Concept for Early Recovery After Surgery in Patients Undergoing Radical Cystectomy for Bladder Cancer: Results of a Prospective Randomized Study Karl A, Buchner A, Becker M, et al. J Urol 2014;191:335–40 Experts’ summary: In the first prospective randomised study evaluating the benefit of a protocol for enhanced recovery after surgery (ERAS) for patients undergoing radical cystectomy (RC), Karl et al. demonstrate that ERAS is associated with significant improvement in quality of life and mobility and decreased postoperative morbidity, demand for analgesia, and stay in the intermediate care unit (ICU). Of 101 consecutive randomised patients, the patients in the ERAS arm (n = 62) had significant improvement in physical and emotional functioning scores, as measured by the European Organisation for Research and Treatment of Cancer quality of life questionnaire QLQ-30 on days 3 and 7 and at discharge, compared with the conservative arm (n = 39), for which there was no improvement. There was a statistically significant decrease in incidence of deep vein thrombosis, wound-healing disorders, and fever in the ERAS arm as well as a significant decrease in amount and time of analgesia used. Patients in the ERAS group spent less time in the ICU (median: 1.8 d vs 2.6 d). There was no significant difference in the time to gastrointestinal events, such as bowel sounds or time to first flatus or bowel movement, or in routine blood parameters or time to discharge for patients in the ERAS arm. The authors concluded that their ERAS regimen had multiple benefits for the postoperative recovery of patients undergoing RC.
recovery from trials in colorectal surgery has been extrapolated to major urologic surgery. This paper presents the first level 1 evidence that the benefits of an ERAS regimen as seen in colorectal surgery are also applicable to RC. Although there is no standardised ERAS regimen, this paper addressed all major aspects of ERAS such as no prolonged fasting or bowel preparation, preoperative caloric loading, standardised anaesthetic protocols, and early postoperative catheter and drain removal, mobilisation, and oral feeding. The improvement in quality of life in the ERAS arm is an important finding studied by the authors and one that has not been addressed in earlier papers studying ERAS in RC. Should an ERAS protocol be the new standard of care for RC? Although there is insufficient evidence for widespread adoption of ERAS, there is now compelling evidence that ERAS is likely to accelerate the recovery of patients undergoing RC, and it is imperative for us to review the traditional perioperative management of RC. A multidisciplinary approach involving surgeons, anaesthetists, nurses, dieticians, and allied health professionals is one of the key paradigm shifts that is now needed to optimise the recovery of these patients. Conflicts of interest: The authors have nothing to disclose. Nikhil Saprea, Declan G. Murphya,b,c,* a
Department of Urology and Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia b
Division of Cancer Surgery, University of Melbourne,
Peter MacCallum Cancer Centre, Melbourne, Australia c
Epworth Prostate Centre, Epworth Healthcare, Richmond, Australia
*Corresponding author. Division of Cancer Surgery, Peter MacCallum Cancer Centre, St. Andrews Place, East Melbourne, Victoria 3002, Australia.
Experts’ comments: So far, overwhelming evidence of the benefits of ERAS for decreasing postoperative morbidity and improving postoperative
E-mail address: [email protected] (D.G. Murphy). http://dx.doi.org/1016/j.eururo.2014.05.024
EUROPEAN UROLOGY 66 (2014) 386–392
Re: A New Concept for Early Recovery After Surgery in Patients Undergoing Radical Cystectomy for Bladder Cancer: Results of a Prospective Randomized Study Karl A, Buchner A, Becker M, et al. J Urol 2014;191:335–40 Experts’ summary: In the first prospective randomised study evaluating the benefit of a protocol for enhanced recovery after surgery (ERAS) for patients undergoing radical cystectomy (RC), Karl et al. demonstrate that ERAS is associated with significant improvement in quality of life and mobility and decreased postoperative morbidity, demand for analgesia, and stay in the intermediate care unit (ICU). Of 101 consecutive randomised patients, the patients in the ERAS arm (n = 62) had significant improvement in physical and emotional functioning scores, as measured by the European Organisation for Research and Treatment of Cancer quality of life questionnaire QLQ-30 on days 3 and 7 and at discharge, compared with the conservative arm (n = 39), for which there was no improvement. There was a statistically significant decrease in incidence of deep vein thrombosis, wound-healing disorders, and fever in the ERAS arm as well as a significant decrease in amount and time of analgesia used. Patients in the ERAS group spent less time in the ICU (median: 1.8 d vs 2.6 d). There was no significant difference in the time to gastrointestinal events, such as bowel sounds or time to first flatus or bowel movement, or in routine blood parameters or time to discharge for patients in the ERAS arm. The authors concluded that their ERAS regimen had multiple benefits for the postoperative recovery of patients undergoing RC.
recovery from trials in colorectal surgery has been extrapolated to major urologic surgery. This paper presents the first level 1 evidence that the benefits of an ERAS regimen as seen in colorectal surgery are also applicable to RC. Although there is no standardised ERAS regimen, this paper addressed all major aspects of ERAS such as no prolonged fasting or bowel preparation, preoperative caloric loading, standardised anaesthetic protocols, and early postoperative catheter and drain removal, mobilisation, and oral feeding. The improvement in quality of life in the ERAS arm is an important finding studied by the authors and one that has not been addressed in earlier papers studying ERAS in RC. Should an ERAS protocol be the new standard of care for RC? Although there is insufficient evidence for widespread adoption of ERAS, there is now compelling evidence that ERAS is likely to accelerate the recovery of patients undergoing RC, and it is imperative for us to review the traditional perioperative management of RC. A multidisciplinary approach involving surgeons, anaesthetists, nurses, dieticians, and allied health professionals is one of the key paradigm shifts that is now needed to optimise the recovery of these patients. Conflicts of interest: The authors have nothing to disclose. Nikhil Saprea, Declan G. Murphya,b,c,* a
Department of Urology and Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia b
Division of Cancer Surgery, University of Melbourne,
Peter MacCallum Cancer Centre, Melbourne, Australia c
Epworth Prostate Centre, Epworth Healthcare, Richmond, Australia
*Corresponding author. Division of Cancer Surgery, Peter MacCallum Cancer Centre, St. Andrews Place, East Melbourne, Victoria 3002, Australia.
Experts’ comments: So far, overwhelming evidence of the benefits of ERAS for decreasing postoperative morbidity and improving postoperative
E-mail address: [email protected] (D.G. Murphy). http://dx.doi.org/1016/j.eururo.2014.05.024
