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Enhanced recovery after surgery for radical cystectomy with ileal urinary diversion: a multi-institutional, randomized, controlled trial from the Chinese bladder cancer consortium

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Abstract

Purpose

Enhanced recovery after surgery (ERAS) has played an important role in recovery management for radical cystectomy with ileal urinary diversion (RC-IUD). This study is to evaluate ERAS compared with the conventional recovery after surgery (CRAS) for RC-IUD.

Methods

From October 2014 and July 2016, bladder cancer patients scheduled for curative treatment from 25 centers of Chinese Bladder Cancer Consortium were randomly assigned to either ERAS or CRAS group. Primary endpoint was the 30-day complication rate. Secondary endpoints included recovery of fluid and regular diet, flatus, bowel movement, ambulation, and length of stay (LOS) postoperatively. Follow-up period was 30-day postoperatively.

Results

There were 144 ERAS and 145 CRAS patients. Postoperative complications occurred in 25.7 and 30.3% of the ERAS and CRAS patients with 55 complications in each group, respectively (p = 0.40). There was no significant difference between groups in major complications (p = 0.82), or type of complications (p = 0.99). The ERAS group had faster recovery of bowel movements (median 88 versus 100 h, p = 0.01), fluid diet tolerance (68 versus 96 h, p < 0.001), regular diet tolerance (125 versus 168 h, p = 0.004), and ambulation (64 versus 72 h, p = 0.047) than the CRAS group, but similar time to flatus and LOS.

Conclusions

ERAS did not increase 30-day complications compared with CRAS after RC. ERAS may be better than CRAS in terms of bowel movement, tolerance of fluid and regular diet, and ambulation.

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Abbreviations

BCa:

Bladder cancer

CBCC:

Chinese bladder cancer consortium

CRAS:

Conventional recovery after surgery

ERAS:

Enhanced recovery after surgery

LOS:

Length of stay

NGT:

Nasogastric tube

RC:

Radical cystectomy

RCT:

Randomized controlled trial

RC-IUD:

Radical cystectomy with ileal urinary diversion

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Author information

Author notes

  1. Tianxin Lin and Kaiwen Li have contributed equally to this study.

Authors and Affiliations

  1. Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 W Yanjiang Road, Yuexiu District, Guangzhou, 510120, Guangdong, China

    Tianxin Lin, Kaiwen Li, Hao Liu & Jian Huang

  2. Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China

    Xueyi Xue, Ning Xu & Yong Wei

  3. Department of Urology, Southwest Hospital, Third Military Medical University, Chongqing, China

    Zhiwen Chen & Xiaozhou Zhou

  4. Department of Urology, Xiangya Hospital of Central South University, Changsha, Hunan, China

    Lin Qi, Wei He & Shiyu Tong

  5. Department of Urology, The Third Affiliated Hospital, Third Military Medical University, Chongqing, China

    Fengshuo Jin & Xudong Liu

  6. Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China

    Qiang Wei & Ping Han

  7. Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Xin Gou & Weiyang He

  8. Department of Urology, Chinese PLA General Hospital, Beijing, China

    Xu Zhang & Guoqiang Yang

  9. Department of Urology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China

    Zhoujun Shen, Tianyuan Xu & Xin Xie

  10. Department of Urology, Renji Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China

    Wei Xue & Ming Cao

  11. Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China

    Jin Yang & Jianyun Hu

  12. Department of Urology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China

    Fubao Chen, Peijun Li, Guangyong Li & Tong Xu

  13. Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China

    Ye Tian & Wenying Wang

  14. Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China

    Dongkui Song, Lei Shi, Xiaoming Yang & Yang Yang

  15. Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, China

    Benkang Shi, Yaofeng Zhu & Xigao Liu

  16. Department of Urology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China

    Jinchun Xing, Zhun Wu, Kaiyan Zhang & Wei Li

  17. Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China

    Chaozhao Liang & Cheng Yang

  18. Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China

    Wei Li & Jinchun Qi

  19. Department of Urology, Shanghai Changhai Hospital of Second Military Medical University, Shanghai, China

    Chuanliang Xu & Weidong Xu

  20. Department of Urology, Peking University First Hospital, Beijing, China

    Liqun Zhou & Lin Cai

  21. Department of Urology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China

    En’ci Xu, Weizhong Cai, Minggao Weng & Yiming Su

  22. Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China

    Fangjian Zhou, Lijuan Jiang, Zhuowei Liu & Qiuhong Chen

  23. Department of Urology, Wuhan General Hospital of Guangzhou Military Command, Wuhan, Hubei, China

    Tiejun Pan, Bo Liu & Yu Zhou

  24. Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China

    Xin Gao, Jianguang Qiu, Jie Situ & Cheng Hu

  25. Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China

    Shan Chen & Yupeng Zheng

  26. Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China

    Jian Huang

Authors
  1. Tianxin Lin
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  2. Kaiwen Li
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  3. Hao Liu
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  4. Xueyi Xue
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  5. Ning Xu
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  6. Yong Wei
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  7. Zhiwen Chen
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  8. Xiaozhou Zhou
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  9. Lin Qi
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  10. Wei He
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  11. Shiyu Tong
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  12. Fengshuo Jin
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  13. Xudong Liu
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  14. Qiang Wei
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  15. Ping Han
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  16. Xin Gou
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  17. Weiyang He
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  18. Xu Zhang
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  20. Zhoujun Shen
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  21. Tianyuan Xu
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  30. Tong Xu
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  34. Lei Shi
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  41. Zhun Wu
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  42. Kaiyan Zhang
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  43. Wei Li
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  44. Chaozhao Liang
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  45. Cheng Yang
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  46. Wei Li
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  50. Liqun Zhou
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  51. Lin Cai
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  54. Minggao Weng
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  55. Yiming Su
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  56. Fangjian Zhou
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  57. Lijuan Jiang
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  58. Zhuowei Liu
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  59. Qiuhong Chen
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  60. Tiejun Pan
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  61. Bo Liu
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  62. Yu Zhou
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  63. Xin Gao
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  67. Shan Chen
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  68. Yupeng Zheng
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  69. Jian Huang
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Contributions

Jian Huang had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Jian Huang, Tianxin Lin, and Kaiwen Li. Acquisition of data: Hao Liu, Xueyi Xue, Ning Xu, Yong Wei, Zhiwen Chen, Xiaozhou Zhou, Lin Qi, Wei He, Shiyu Tong, Fengshuo Jin, Xudong Liu, Qiang Wei, Ping Han, Xin Gou, Weiyang He, Xu Zhang, Guoqiang Yang, Zhoujun Shen, Tianyuan Xu, Xin Xie, Wei Xue, Ming Cao, Jin Yang, Jianyun Hu, Fubao Chen, Peijun Li, Guangyong Li, Tong Xu, Ye Tian, Wenying Wang, Dongkui Song, Lei Shi, Xiaoming Yang, Yang Yang, Benkang Shi, Yaofeng Zhu, Xigao Liu, Jinchun Xing, Zhun Wu, Kaiyan Zhang, Wei Li, Chaozhao Liang, Cheng Yang, Wei Li, Jinchun Qi, Chuanliang Xu, Weidong Xu, Liqun Zhou, Lin Cai, En’ci Xu, Weizhong Cai, Minggao Weng, Yiming Su, Fangjian Zhou, Lijuan Jiang, Zhuowei Liu, Qiuhong Chen, Tiejun Pan, Bo Liu, Yu Zhou, Xin Gao, Jianguang Qiu, Jie Situ, Cheng Hu, Shan Chen, and Yupeng Zheng. Analysis and interpretation of data: Tianxin Lin and Kaiwwen Li. Drafting of the manuscript: Tianxin Lin and Kaiwwen Li. Critical revision of the manuscript for important intellectual content: Statistical analysis: Hao Liu. Obtaining funding: Jian Huang and Tianxin Lin. Administrative, technical, or material support: none. Supervision: all authors. Other (specify): none.

Corresponding author

Correspondence to Jian Huang.

Ethics declarations

Conflict of interest

All authors certify that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (e.g., employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None.

Funding sources

This study was funded by the National Natural Science Foundation of China (Nos. 81572514, U1301221, 81472384, 81402106, 81372729, 81272808, and 81172431), National Natural Science Foundation of Guangdong (Nos. 2016A030313321, 2015A030311011, 2015A030310122, S2013020012671, 07117336, 10151008901000024, 2015A030310091, and 2016A030313185), Science and Technology Program of Guangzhou (Grant Nos. 201604020156 and 201604020177),“Three Big Constructions” funds of Sun Yat-sen University (for Jian Huang and Tianxin Lin), Specialized Research Fund for the Doctoral Program of Higher Education (for Tianxin Lin, 20130171110073), the Fundamental Research Funds for the Central Universities (for Jian Huang), Project Supported by Guangdong Province Higher Vocational Colleges & Schools Pearl River Scholar Funded Scheme (for Tianxin Lin), Elite Young Scholars Program of Sun Yat-Sen Memorial Hospital (for Tianxin Lin, J201401), and National Clinical Key Specialty Construction Project for Department of Urology and Department of Oncology. Grant KLB09001 from the Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University. Grant [2013]163 from the Key Laboratory of Malignant Tumor Molecular Mechanism and Translational Medicine of Guangzhou Bureau of Science and Information Technology. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Ethical approval

All procedures in this study were approved by the local Medical Ethical Committee of Sun Yat-sen Memorial Hospital of Sun Yat-sen University and in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Lin, T., Li, K., Liu, H. et al. Enhanced recovery after surgery for radical cystectomy with ileal urinary diversion: a multi-institutional, randomized, controlled trial from the Chinese bladder cancer consortium. World J Urol 36, 41–50 (2018). https://doi.org/10.1007/s00345-017-2108-3

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