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Title: Enhanced recovery after surgery protocols for radical cystectomy surgery: review of current evidence and local protocols.
Epworth Authors: Murphy, Declan
Lawrentschuk, Nathan
Bolton, Damien
Other Authors: Mir, Maria
Zargar, Homayoun
Keywords: Cystectomy
Radical Cystectomy Surgery
Colorectal Surgery
Enhanced Recovery After Surgery
Post-operative Complications
Post-operative Care
Local Protocols
Preoperative Considerations
Urinary Bladder Neoplasm
​UroRenal & Vascular Clinical Institute, Epworth HealthCare, Richmond, Victoria, Australia
Epworth Prostate Centre, Epworth Healthcare Vic Australia
Issue Date: Jul-2015
Publisher: Wiley
Citation: ANZ J Surg. 2015 Jul-Aug;85(7-8):514-20
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.
DOI: 10.1111/ans.13043
PubMed URL:
ISSN: 1445-2197
Journal Title: ANZ Journal of Surgery
Type: Journal Article
Affiliated Organisations: 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, Melbourne, 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, Melbourne, Victoria, Australia
Type of Clinical Study or Trial: Review
Appears in Collections:Cancer Services
UroRenal, Vascular
Epworth Prostate Centre
Health Administration

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