Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/16415
Title: Enhanced Recovery After Surgery protocols for radical cystectomy surgery: review of current evidence and local protocols
Austin Authors: Mir, Maria C;Zargar, Homayoun;Bolton, Damien M ;Murphy, Declan G;Lawrentschuk, Nathan
Affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
Urology Department, Miller School of Medicine, University of Miami, Florida, USA
Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Peter MacCallum Cancer Center, The University of Melbourne, Melbourne, Victoria, Australia
Olivia Newton-John Cancer Research Institute, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Issue Date: Jul-2015
metadata.dc.date: 2015-03-17
Publication information: ANZ Journal of Surgery 2015; 85(7-8): 514-520
Abstract: BACKGROUND: Radical cystectomy (RC) remains a morbid procedure. The use of Enhanced Recovery After Surgery (ERAS) pathways has proven to reduce care time and post-operative complications after colorectal surgery. There is a high potential for reducing morbidity associated with RC by utilizing ERAS in this setting. The purpose of this review is to examine the current evidence for ERAS in preoperative, intra-operative and post-operative setting of care for RC patients and to propose ERAS evidence-based protocol for patients undergoing RC in the Australian and New Zealand environment. PREOPERATIVE: Patient's medical optimization, avoidance of oral mechanical bowel preparation and emphasis on preoperative administration of high-energy carbohydrate drinks from colorectal literature has led to inclusion of these strategies in the preoperative considerations of ERAS in RC. INTRA-OPERATIVE: Epidural analgesia has an integral role in reducing surgical stress response, improving analgesia and expediting functional recovery and should be included in ERAS RC protocols. Of relevance is 72 h maximum length of its duration. With regard to minimally invasive approach to RC, despite encouraging results from high-volume centres, high-level evidence in this field are lacking (ongoing clinical trials). Standardized anaesthetic protocols with particular emphasis on perioperative fluid management are essential components of ERAS protocols. POST-OPERATIVE: Avoidance of routine nasogastric tube placement, early mobilization and multifaceted approach to optimization of gut function and elimination of post-operative ileus are the cornerstones of post-operative care in the setting of ERAS in RC patients.
URI: http://ahro.austin.org.au/austinjspui/handle/1/16415
DOI: 10.1111/ans.13043
ORCID: 0000-0002-5145-6783
0000-0001-8553-5618
PubMed URL: https://pubmed.ncbi.nlm.nih.gov/25781409
Type: Journal Article
Subjects: Periopearative care
Cystectomy
Postoperative complications
Appears in Collections:Journal articles

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