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ERAS Protocol in Minimal Invasive Urological Surgery

  • Ho-Yin Ngai
  • Chi-Man Ng
  • Eddie Chan
Chapter

Abstract

Radical cystectomy is the standard treatment for muscle-invasive bladder cancer. However, the procedure is associated with high complication rate up to 60%. Most of the patients have high surgical risk with advanced age and multiple comorbidities. Operation procedure is technically demanding. Hemorrhage, infection, bowel-related complications are common after radical cystectomy. Enhanced recovery after surgery (ERAS) protocol has been used in colorectal surgery and has been proven to reduce complication rates and shorten hospital stay. In recent years, many centres has implemented ERAS on patients undergoing radical cystectomy with good results. This chapter will review the current evidence and different aspects of ERAS.

Keywords

ERAS Fast-track Cystectomy Bladder cancer 

References

  1. Adding C, Collins JW, Laurin O, Hosseini A, Wiklund NP. Enhanced recovery protocols (ERP) in robotic cystectomy surgery. Review of current status and trends. Curr Urol Rep. 2015;16(5):32.PubMedCrossRefGoogle Scholar
  2. Al Omran Y, Aziz Q. The brain-gut axis in health and disease. Adv Exper Med Biol. 2014;817:135–53.CrossRefGoogle Scholar
  3. Alberts BD, Woldu SL, Weinberg AC, Danzig MR, Korets R, Badani KK. Venous thromboembolism after major urologic oncology surgery: a focus on the incidence and timing of thromboembolic events after 27,455 operations. Urology. 2014;84:799–806.PubMedCrossRefGoogle Scholar
  4. Altobelli E, Buscarini M, Gill HS, Skinner EC. Readmission rate and causes at 90-day after radical cystectomy in patients on early recovery after surgery protocol. Bladder Cancer. 2017;3(1):51–6.PubMedPubMedCentralCrossRefGoogle Scholar
  5. Arumainayagam N, McGrath J, Jefferson KP, Gillatt DA. Introduction of an enhanced recovery protocol for radical cystectomy. BJU Int. 2008;101(6):698–701.PubMedCrossRefGoogle Scholar
  6. Asao T, Kuwano H, Nakamura J, Morinaga N, Hirayama I, Ide M. Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy. J Am Coll Surg. 2002;195(1):30–2.PubMedCrossRefGoogle Scholar
  7. Awad S, Varadhan KK, Ljungqvist O, Lobo DN. A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery. Clin Nutr. 2013;32:34–44.PubMedCrossRefGoogle Scholar
  8. Azhar RA, Bochner B, Catto J, Goh AC, Kelly J, Patel HD, et al. Enhanced recovery after urological surgery: a contemporary systermatic review of outcomes, key elements, and research needs. Eur Urol. 2016;70:176–87.PubMedPubMedCentralCrossRefGoogle Scholar
  9. Baack Kukreja JE, Kiernan M, Schempp B, Siebert A, Hontar A, Nelson B, et al. Quality Improvement in Cystectomy Care with Enhanced Recovery (QUICCER) study. BJU Int. 2017;119:38–49.PubMedCrossRefGoogle Scholar
  10. Balteskard L, Unneberg K, Mjaaland M, Jenssen TG, Revhaug A. Growth hormone and insulin like growth factor 1 promote intestinal uptake and hepatic release of glutamine in sepsis. Ann Surg. 1998;228(1):131–9.PubMedPubMedCentralCrossRefGoogle Scholar
  11. Bergqvist D, Agnelli G, Cohen AT, Eldor A, Nilsson PE, Le Moigne-Amrani A, et al. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med. 2002;346:975–80.PubMedCrossRefGoogle Scholar
  12. Bertrand J, Siegler N, Murez T, Poinas G, Segui B, Ayuso D, et al. Impact of preoperative immunonutrition on morbidity following cystectomy for bladder cancer: a case-control pilot study. World J Urol. 2014;32:233–7.PubMedCrossRefGoogle Scholar
  13. Bilku DK, Dennison AR, Hall TC, Metcalfe MS, Garcea G. Role of preoperative carbohydrate loading: a systematic review. Ann R Coll Surg Engl. 2014;96:15–22.PubMedPubMedCentralCrossRefGoogle Scholar
  14. Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev. 2003;(4):CD004423.Google Scholar
  15. Caumo W, Hidalgo MP, Schmidt AP, Iwamoto CW, Adamatti LC, Bergmann J, et al. Effect of pre-operative anxiolysis on postoperative pain response in patients undergoing total abdominal hysterectomy. Anaesthesia. 2002;57(8):740–6.PubMedCrossRefGoogle Scholar
  16. 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;32:879–87.PubMedCrossRefGoogle Scholar
  17. Chang SS, Cookson MS, Baumgartner RG, Wells N, Smith JA Jr. Analysis of early complications after radical cystectomy: results of collaborative care pathway. J Urol. 2002;167(5):2012–6.PubMedCrossRefGoogle Scholar
  18. Chipollini J, Tang DH, Hussein K, Patel SY, Garcia-Getting RE, Pow-Sang JM, et al. Does implementing an enhanced recovery after surgery protocol increase hospital charges? Comparisons from a radical cystectomy program at a specialty cancer center. Urology. 2017;105:108–12.PubMedCrossRefGoogle Scholar
  19. Choi H, Kang SH, Yoon DK, Kang SG, Ko HY, du Moon G, et al. Chewing gum has a stimulatory effect on bowel motility in patients after open or robotic radical cystectomy for bladder cancer: a prospective randomized comparative study. Urology. 2011;77(4):884–90.PubMedCrossRefGoogle Scholar
  20. Chughtai B, Abraham C, Finn D, Rosenberg S, Yarlagadda B, Perrotti M. Fast track open partial nephrectomy: reduced postoperative length of stay with a goal-directed pathway does not compromise outcome. Adv Urol. 2008:507543.Google Scholar
  21. Collins JW, Patel H, Adding C, Annerstedt M, Dasgupta P, Khan SM, et al. Enhanced recovery after robot-assisted radical cystectomy: EAU robotic urology section scientific working group consensus view. Eur Urol. 2016;70(4):649–60.PubMedCrossRefGoogle Scholar
  22. Djaladat H, Daneshmand S. Enhanced recovery pathway following radical cystectomy. Curr Opin Urol. 2014;24(2):135–9.PubMedCrossRefGoogle Scholar
  23. Donat SM, Slaton JW, Pisters LL, Swanson DA. Early nasogastric tube removal combined with metoclopramide after radical cystectomy and urinary diversion. J Urol. 1999;162:1599–602.PubMedCrossRefGoogle Scholar
  24. European Association of Urology. Guideline on urological infection. 2015. https://uroweb.org/wp-content/uploads/19-Urological-infections_LR2.pdf
  25. Firoozfard B, Christensen T, Kristensen JK, Mogensen S, Kehlet H. Fast-track open transperitoneal nephrectomy. Scand J Urol Nephrol. 2003;37(4):305–8.PubMedCrossRefGoogle Scholar
  26. Fitzgerald JE, Ahmed I. Systematic review and meta-analysis of chewing-gum therapy in the reduction of postoperative paralytic ileus following gastrointestinal surgery. World J Surg. 2009;33:2557–66.PubMedCrossRefGoogle Scholar
  27. Furlong C. Smoking cessation and its effects on outcomes of surgical interventions. 2005. http://www.thehealthwell.info/node/27981. Accessed 30 Oct 2017.
  28. Giglio MT, Marucci M, Testini M, Brienza N. Goal-directed hemodynamic therapy and gastrointestinal complications in major surgery: a meta-analysis of randomized controlled trials. Br J Anaesth. 2009;103:637–46.PubMedCrossRefGoogle Scholar
  29. Gregg JR, Cookson MS, Phillips S, Salem S, Chang SS, Clark PE, et al. Effect of preoperative nutritional deficiency on mortality after radical cystectomy for bladder cancer. J Urol. 2011;185(1):90–6.PubMedCrossRefGoogle Scholar
  30. Güenaga KF, Matos D, Wille-Jørgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev. 2011;(9):CD001544.Google Scholar
  31. Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, McNaught CE, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World J Surg. 2013;37:259–84.PubMedCrossRefGoogle Scholar
  32. Hamilton-Reeves JM, Bechtel MD, Hand LK, Schleper A, Yankee TM, Chalise P, et al. Effects of immunonutrition for cystectomy on immune response and infection rates: a pilot randomized controlled clinical trial. Eur Urol. 2016;69:389–92.PubMedCrossRefGoogle Scholar
  33. Hashad MM, Atta M, Elabbady A, Elfiky S, Khattab A, Kotb A. Safety of no bowel preparation before ileal urinary diversion. BJU Int. 2012;110:E1109–13.PubMedCrossRefGoogle Scholar
  34. Hausel J, Nygren J, Lagerkranser M, Hellström PM, Hammarqvist F, Almström C, Lindh A, Thorell A, Ljungqvist O. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Anesth Analg. 2001;93(5):1344–50.PubMedCrossRefGoogle Scholar
  35. Jensen BT, Petersen AK, Jensen JB, Laustsen S, Borre M. Efficacy of a multiprofessional rehabilitation programme in radical cystectomy pathways: a prospective randomized controlled trial. Scand J Urol. 2015;49:133–41.PubMedCrossRefGoogle Scholar
  36. Kakkar AK, Haas S, Wolf H, Encke A. Evaluation of perioperative fatal pulmonary embolism and death in cancer surgical patients: the MC-4 cancer substudy. Thromb Haemost. 2005;94:867–71.PubMedGoogle Scholar
  37. Karl A, Rittler P, Buchner A, Fradet V, Speer R, Walther S, et al. Prospective assessment of malnutrition in urologic patients. Urology. 2009;73:1072–6.PubMedCrossRefGoogle Scholar
  38. Kauf TL, Svatek RS, Amiel G, Beard TL, Chang SS, Fergany A, et al. Alvimopan, a peripherally acting μ-opioid receptor antagonist, is associated with reduced costs after radical cystectomy: economic analysis of a phase 4 randomized, controlled trial. J Urol. 2014;s191:1721–7.CrossRefGoogle Scholar
  39. Kauffman EC, Ng CK, Lee MM, Otto BJ, Portnoff A, Wang GJ, et al. Critical analysis of complications after robotic-assisted radical cystectomy with identification of preoperative and operative risk factors. BJU Int. 2010;105:520–7.PubMedCrossRefGoogle Scholar
  40. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78:606–17.PubMedCrossRefGoogle Scholar
  41. Khan S, Gatt M, Horgan A, Anderson I, MacFie J. Guidelines for implementation of enhanced recovery protocols. 2009. http://www.asgbi.org.uk/en/publications/issues_in_professional_practice.cfm
  42. Kim SP, Shah ND, Karnes EJ, Weight CJ, Frank I, Moriarty JP, et al. The implications of hospital acquired adverse events on mortality, length of stay and costs for patients undergoing radical cystectomy for bladder cancer. J Urol. 2012;187(6):2011–7.PubMedCrossRefGoogle Scholar
  43. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22:321–36.PubMedCrossRefGoogle Scholar
  44. Koo V, Brace H, Shahzad A, Lynn N. The challenges of implementing Enhanced Recovery Programme in urology. Int J Urol Nurs. 2013;7(2):106–10.CrossRefGoogle Scholar
  45. Kouba EJ, Wallen EM, Pruthi RS. Gum chewing stimulates bowel motility in patients undergoing radical cystectomy with urinary diversion. Urology. 2007;70(6):1053–6.PubMedCrossRefGoogle Scholar
  46. Koupparis A, Dunn J, Gillatt D, Rowe E. Improvement of an enhanced recovery protocol for radical cystectomy. J Clin Urol. 2010;3(6):237–40.Google Scholar
  47. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of wound infection and temperature group. N Engl J Med. 1996;334:1209–15.PubMedCrossRefGoogle Scholar
  48. Lambert E, Carey S. Practice guideline recommendations on perioperative fasting: a systematic review. JPEN J Parenter Enteral Nutr. 2016;40(8):1158–65.PubMedCrossRefGoogle Scholar
  49. Large MC, Kiriluk KJ, DeCastro GJ, Patel AR, Prasad S, Jayram G, et al. The impact of mechanical bowel preparation on postoperative complications for patients undergoing cystectomy and urinary diversion. J Urol. 2012;188:1801–5.PubMedCrossRefGoogle Scholar
  50. Lee CT, Chang SS, Kamat AM, Amiel G, Beard TL, Fergany A, et al. Alvimopan accelerates gastrointestinal recovery after radical cystectomy: a multicenter randomized placebo-controlled trial. Eur Urol. 2014;66:265–72.PubMedCrossRefGoogle Scholar
  51. Lewis SJ, Andersen HK, Thomas S. Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: a systematic review and meta-analysis. J Gastrointest Surg. 2009;13:569–75.PubMedCrossRefGoogle Scholar
  52. Lindström D, Sadr Azodi O, Wladis A, Tønnesen H, Linder S, Nåsell H, et al. Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. Ann Surg. 2008;248(5):739–45.PubMedCrossRefGoogle Scholar
  53. Ljungqvist O, Jonathan E. Rhoads lecture 2011: insulin resistance and enhanced recovery after surgery. JPEN J Parenter Enteral Nutr. 2012;36(4):389–98.PubMedCrossRefGoogle Scholar
  54. Magheli A, Knoll N, Lein M, Hinz S, Kempkensteffen C, Gralla O. Impact of fast-track postoperative care on intestinal function, pain, and length of hospital stay after laparoscopic radical prostatectomy. J Endourol. 2011;25(7):1143–7.PubMedCrossRefGoogle Scholar
  55. Mattei A, Birkhaeuser FD, Baermann C, Warncke SH, Studer UE. To stent or not to stent perioperatively the ureteroileal anastomosis of ileal orthotopic bladder substitutes and ileal conduits? Results of a prospective randomized trial. J Urol. 2008;179:582–6.PubMedCrossRefGoogle Scholar
  56. Musch M, et al. Comparison of early postoperative morbidity after robot-assisted and open radical cystectomy: results of a prospective observational study. Brit J Urol. 2014;113:458–67.CrossRefGoogle Scholar
  57. Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev. 2007;(3):CD004929.Google Scholar
  58. Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF. Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg. 2014;101(3):172–88.PubMedCrossRefGoogle Scholar
  59. Nix J, Smith A, Kurpad R, Nielsen ME, Wallen EM, Pruthi RS. Prospective randomized controlled trial of robotic versus open radical cystectomy for bladder cancer: perioperative and pathologic results. Eur Urol. 2010;57:196–201.PubMedCrossRefGoogle Scholar
  60. Nygren J, Thacker J, Carli F, Fearon KC, Norderval S, Lobo DN. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Clin Nutr. 2012;31:801–16.PubMedCrossRefGoogle Scholar
  61. Pedziwiatr M, Kisialeuski M, Wierdak M, Stanek M, Natkaniec M, Matlok M, et al. Early implementation of Enhanced Recovery After Surgery (ERAS) protocol—compliance improves outcomes: a prospective cohort study. Int J Surg. 2015;21:75–81.PubMedCrossRefGoogle Scholar
  62. Pillai P, McEleavy I, Gaughan M, Snowden C, Nesbitt I, Durkan G, et al. A double-blind randomized controlled clinical trial to assess the effect of Doppler optimized intraoperative fluid management on outcome following radical cystectomy. J Urol. 2011;186:2201–6.PubMedCrossRefGoogle Scholar
  63. Pruthi RS, Nielsen M, Smith A, Nix J, Schultz H, Wallen EM. Fast track program in patients undergoing radical cystectomy: results in 362 consecutive patients. J Am Coll Surg. 2010;210(1):93–9.PubMedCrossRefGoogle Scholar
  64. Rao W, Zhang X, Zhang J, Yan R, Hu Z, Wang Q. The role of nasogastric tube in decompression after elective colon and rectum surgery: a meta-analysis. Int J Color Dis. 2011;26:423–9.CrossRefGoogle Scholar
  65. Recart A, Duchene D, White PF, Thomas T, Johnson DB, Cadeddu JA. Efficacy and safety of fast-track recovery strategy for patients undergoing laparoscopic nephrectomy. J Endourol. 2005;19(10):1165–9.PubMedCrossRefGoogle Scholar
  66. Richards KA, Steinberg GD. Perioperative outcomes in radical cystectomy: how to reduce morbidity? Curr Opin Urol. 2013;23:456–65.PubMedCrossRefGoogle Scholar
  67. Sachdeva A, Dalton M, Amaragiri SV, Lees T. Elastic compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev. 2010;(7):CD001484.Google Scholar
  68. Sammour T, Zargar-Shoshtari K, Bhat A, Kahokehr A, Hill AG. A programme of Enhanced Recovery After Surgery (ERAS) is a cost-effective intervention in elective colonic surgery. N Z Med J. 2010;123(1319):61–70.PubMedGoogle Scholar
  69. Schuster R, Grewal N, Greaney GC, Waxman K. Gum chewing reduces ileus after elective open sigmoid colectomy. Arch Surg. 2006;141:174–6.PubMedCrossRefGoogle Scholar
  70. Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C, et al. Defining early morbidity of radical cystectomy for subjects with bladder cancer using a standardized reporting methodology. Eur Urol. 2009;55:164–74.PubMedCrossRefGoogle Scholar
  71. Short V, Herbert G, Perry R, Atkinson C, Ness AR, Penfold C et al. Chewing gum for postoperative recovery of gastrointestinal function. Cochrane Database Syst Rev. 2015;(2):CD006506.Google Scholar
  72. Simpson JC, Moonesinghe SR, Grocott MP, Kuper M, McMeeking A, Oliver CM, et al. Enhanced recovery from surgery in the UK: an audit of the Enhanced Recovery Partnership Programme 2009-2012. Br J Anaesth. 2015;115(4):560–8.PubMedCrossRefGoogle Scholar
  73. Smith I, Kranke P, Murat I, Smith A, O’Sullivan G, Soreide E, Spies C, et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011;28:556–69.PubMedCrossRefGoogle Scholar
  74. Soop M, Nygren J, Thorell A, et al. Preoperative oral carbohydrate treatment attenuates endogenous glucose release 3 days after surgery. Clin Nutr. 2004;23:733–41.PubMedCrossRefGoogle Scholar
  75. Svanfeldt M, Throell A, Hausel J, Soop M, Rooyackers O, Nygren J, et al. Randomized clinical trial of the effect of preoperative oral carbohydrate treatment on postoperative whole-body protein and glucose kinetics. Br J Surg. 2007;94:1342–50.PubMedCrossRefGoogle Scholar
  76. The BAUS ERP Group. BAUS enhanced recovery pathway. The British Association of Urological Surgeons. 2015. https://www.baus.org.uk/_userfiles/pages/files/Publications/ERP%20with%20KNB%20markups.pdf
  77. Tobis S, Heinlen JE, Ruel N, Lau C, Kawachi M, Wilson T, et al. Effect of alvimopan on return of bowel function after robot-assisted radical cystectomy. J Laparoendosc Adv Surg Tech A. 2014;24(10):693–7.PubMedCrossRefGoogle Scholar
  78. Tonnesen H, Nielsen PR, Lauritzen JB, Moller AM. Smoking and alcohol intervention before surgery: evidence for best practice. Br J Anaesth. 2009;102:297–306.PubMedCrossRefGoogle Scholar
  79. Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr. 2010;29(4):434–40.PubMedCrossRefGoogle Scholar
  80. Walker KJ, Smith AF. Premedication for anxiety in adult day surgery. Cochrane Database Syst Rev. 2009;(4):CD002192.Google Scholar
  81. Wuethrich PY, Burkhard FC, Thalmann GN, Stueber F, Studer UE. Restrictive deferred hydration combined with preemptive norepinephrine infusion during radical cystectomy reduces postoperative complications and hospitalization time: a randomized clinical trial. Anaesthesiology. 2014;120(2):365–77.CrossRefGoogle Scholar
  82. Xu R, Zhao X, Zhong Z, Zhang L. No advantage is gained by preoperative bowel preparation in radical cystectomy and ileal conduit: a randomized controlled trial of 86 patients. Int Urol Nephrol. 2010;42:947–50.PubMedCrossRefGoogle Scholar
  83. Yuh BE, Nazmy M, Ruel NH, Jankowski JT, Menchaca AR, Torrey RR, et al. Standardized analysis of frequency and severity of complications after robot-assisted radical cystectomy. Eur Urol. 2012;62(5):806–13.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Ho-Yin Ngai
    • 1
  • Chi-Man Ng
    • 1
  • Eddie Chan
    • 2
  1. 1.Division of Urology, Department of SurgeryQueen Elizabeth HospitalKowloonHong Kong
  2. 2.Urology, Department of SurgeryThe Chinese University of Hong KongKowloonHong Kong

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