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Sun X, Liu C, Zhang C, Zhang Z. Nomogram for predicting postoperative ileus after radical cystectomy and urinary diversion: a retrospective single-center study. Ann Med 2024; 56:2329125. [PMID: 38498939 PMCID: PMC10949833 DOI: 10.1080/07853890.2024.2329125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/23/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVE To predict the incidence of postoperative ileus in bladder cancer patients after radical cystectomy. METHODS We retrospectively analyzed the perioperative data of 452 bladder cancer patients who underwent radical cystectomy with urinary diversion at the Second Hospital of Tianjin Medical University between 2016 and 2021. Univariate and multivariate logistic regression were used to identify the risk factors for postoperative ileus. Finally, a nomogram model was established and verified based on the independent risk factors. RESULTS Our study revealed that 96 patients (21.2%) developed postoperative ileus. Using multivariate logistic regression analysis, we found that the independent risk factors for postoperative ileus after radical cystectomy included age > 65.0 years, high or low body mass index, constipation, hypoalbuminemia, and operative time. We established a nomogram prediction model based on these independent risk factors. Validation by calibration curves, concordance index, and decision curve analysis showed a strong correlation between predicted and actual probabilities of occurrence. CONCLUSION Our nomogram prediction model provides surgeons with a simple tool to predict the incidence of postoperative ileus in bladder cancer patients undergoing radical cystectomy.
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Affiliation(s)
- Xiaoyu Sun
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Chang Liu
- Department of Urology, Renmin Hospital of Wuhan Economic and Technological Development Zone (Hannan), Wuhan, China
| | - Changwen Zhang
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhihong Zhang
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
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Murtaza R, Clarke O, Sivakanthan T, Al-Sarireh H, Al-Sarireh A, Raza MM, Navid AZ, Ali B, Hajibandeh S, Hajibandeh S. Effect of Alvimopan on Postoperative Ileus and Length of Hospital Stay in Patients Undergoing Bowel Resection: A Systematic Review and Meta-Analysis. Am Surg 2024:31348241265149. [PMID: 39031053 DOI: 10.1177/00031348241265149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
AIMS The aim is to investigate the effect of alvimopan on postoperative ileus and length of hospital stay in patients undergoing bowel resection. METHODS The PRISMA statement standards were followed to conduct a systematic review and meta-analysis. The available literature was searched to identify all studies comparing alvimopan with no alvimopan in patients undergoing bowel resection. Postoperative ileus and length of hospital stay were the primary outcomes, and time to first bowel motion was the secondary outcome. Random-effects modeling was applied for analyses. RESULTS Analysis of 94 833 patients from 26 studies showed that alvimopan was associated with lower risk of postoperative ileus (OR: .57, 95% CI .48 to .67, P <.00001; high GRADE certainty), shorter length of hospital stay (MD: -1.08 day, 95% CI -1.36 to -.81, P < .00001; moderate GRADE certainty), and shorter time to first bowel motion (MD: -.43 day, 95% CI -.58 to -.28, P < .00001; moderate GRADE certainty). Separate analyses of randomized controlled trials and observational studies showed similar findings. Subgroup analyses suggested consistent findings in patients undergoing elective bowel resection, emergency bowel resection, and open surgery; however, alvimopan did not improve the outcomes in patients undergoing minimally invasive surgery. CONCLUSION Robust evidence supports the routine use of alvimopan in patients undergoing open bowel resection as indicated by lower risk of postoperative ileus and shorter length of hospital stay. We support incorporation of alvimopan into enhanced recovery after surgery programs for the procedures involving open bowel resection. The role of alvimopan in minimally invasive bowel resection needs more research.
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Affiliation(s)
- Rashid Murtaza
- Department of General Surgery, Royal Gwent Hospital, Newport, UK
| | - Olivia Clarke
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | | | | | | | | | - Ahmad Zia Navid
- Department of General Surgery, Royal Shrewsbury Hospital, Shrewsbury, UK
| | - Baqar Ali
- Department of General Surgery, Royal Oldham Hospital, Oldham, UK
| | - Shahin Hajibandeh
- Department of General surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK
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Thakker PU, Refugia JM, Wolff D, Casals R, Able C, Temple D, Rodríguez AR, Tsivian M. Ileal Conduit versus Cutaneous Ureterostomy after Open Radical Cystectomy: Comparison of 90-Day Morbidity and Tube Dependence at Intermediate Term Follow-Up. J Clin Med 2024; 13:911. [PMID: 38337606 PMCID: PMC10856161 DOI: 10.3390/jcm13030911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/15/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
Background: This study aims to compare perioperative morbidity and drainage tube dependence following open radical cystectomy (ORC) with ileal conduit (IC) or cutaneous ureterostomy (CU) for bladder cancer. Methods: A single-center, retrospective cohort study of patients undergoing ORC with IC or CU urinary diversion between 2020 and 2023 was carried out. The 90-day perioperative morbidity, as per Clavien-Dindo (C.D.) complication rates (Minor C.D. I-II, Major C.D. III-V), and urinary drainage tube dependence (ureteral stent or nephrostomy tube) after tube-free trial were assessed. Results: The study included 56 patients (IC: 26, CU: 30) with a 14-month median follow-up. At 90 days after IC or CU, the frequencies of any, minor, and major C.D. complications were similar (any-69% vs. 77%; minor-61% vs. 73%; major-46% vs. 30%, respectively, p > 0.2). Tube-free trial was performed in 86% of patients with similar rates of tube replacement (19% IC vs. 32% CU, p = 0.34) and tube-free survival at 12 months was assessed (76% IC vs. 70% CU, p = 0.31). Conclusions: Compared to the ORC+IC, ORC+CU has similar rates of both 90-day perioperative complications and 12-month tube-free dependence. CU should be offered to select patients as an alternative to IC urinary diversion after RC.
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Affiliation(s)
- Parth U. Thakker
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA; (P.U.T.)
| | - Justin Manuel Refugia
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA; (P.U.T.)
| | - Dylan Wolff
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA; (P.U.T.)
| | - Randy Casals
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA; (P.U.T.)
| | - Corey Able
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Davis Temple
- Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Alejandro R. Rodríguez
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA; (P.U.T.)
| | - Matvey Tsivian
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA; (P.U.T.)
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Yanada BA, Dias BH, Corcoran NM, Zargar H, Bishop C, Wallace S, Hayes D, Huang JG. Implementation of the enhanced recovery after surgery protocol for radical cystectomy patients: A single centre experience. Investig Clin Urol 2024; 65:32-39. [PMID: 38197749 PMCID: PMC10789537 DOI: 10.4111/icu.20230282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/18/2023] [Accepted: 11/22/2023] [Indexed: 01/11/2024] Open
Abstract
PURPOSE The enhanced recovery after surgery (ERAS) protocol for radical cystectomy aims to facilitate postoperative recovery and hasten a return to normal daily activities. This study aims to report on the perioperative outcomes of implementation of an ERAS protocol at a single Australian institution. MATERIALS AND METHODS We identified 73 patients with pT1-T4 bladder cancer who underwent open radical cystectomy at Western Health, Victoria between June 2016 and August 2021. A retrospective analysis of a prospectively maintained database was performed. Perioperative outcomes included length of hospital stay, nasogastric tube requirement and duration of postoperative ileus. RESULTS The median age was 74 years (interquartile range [IQR] 66-78) for the ERAS group and 70 years (IQR 65-78) for the pre-ERAS group patients. All patients in each group underwent ileal conduit formation. The median length of hospital stay was 7.0 days (IQR 7.0-9.3) for the ERAS group and 12.0 days (IQR 8.0-16.0) for the pre-ERAS group (p=0.003). Within the ERAS group, 25.0% had a postoperative ileus, and 25.0% had a nasogastric tube inserted, compared with 64.9% (p=0.001) and 45.9% (p=0.063) respectively within pre-ERAS group. The median bowel function recovery time, defined as duration from surgery to first bowel action, was 5.0 days (IQR 4.0-7.0) in the ERAS group and 7.5 days (IQR 5.0-8.5) in the pre-ERAS group (p=0.016). CONCLUSIONS Implementation of an ERAS protocol is associated with a reduction in hospital length of stay, postoperative ileus and bowel function recovery time.
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Affiliation(s)
- Brendan A Yanada
- Department of Urology, Western Health, Footscray, VIC, Australia.
| | - Brendan H Dias
- Department of Urology, Western Health, Footscray, VIC, Australia
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
| | - Niall M Corcoran
- Department of Urology, Western Health, Footscray, VIC, Australia
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
- Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - Homayoun Zargar
- Department of Urology, Western Health, Footscray, VIC, Australia
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
| | - Conrad Bishop
- Department of Urology, Western Health, Footscray, VIC, Australia
| | - Sue Wallace
- Department of Urology, Western Health, Footscray, VIC, Australia
| | - Diana Hayes
- Department of Urology, Western Health, Footscray, VIC, Australia
| | - James G Huang
- Department of Urology, Western Health, Footscray, VIC, Australia
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Nabavizadeh R, Rodrigues Pessoa R, Dumbrava MG, Packiam VT, Thapa P, Tarrell R, Tollefson MK, Jeffrey Karnes R, Frank I, Khanna A, Shah P, Sharma V, Boorjian SA. Cutaneous Ureterostomy Following Radical Cystectomy for Bladder Cancer: A Contemporary Series. Urology 2023; 181:162-166. [PMID: 37689248 DOI: 10.1016/j.urology.2023.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE To report peri-operative outcomes of a contemporary series of bladder cancer patients undergoing radical cystectomy (RC) with cutaneous ureterostomy (CU) urinary diversion at a tertiary referral center. METHODS We retrospectively identified patients who underwent RC with CU at Mayo Clinic between 2016 and 2021. Clinicopathologic and perioperative characteristics were analyzed using standard descriptive statistics. RESULTS A total of 31 patients underwent RC with CU at our institution. Median age was 72years and 21 were male. This was highly comorbid cohort (83% had an American Society of Anesthesiologists [ASA] Physical Status Classification System ≥3; median Charlson Comorbidity index= 8). Median time to flatus, tolerating regular diet, and length of stay were 3 (interquartile range [IQR] 3-3), 3 (IQR 3-4), and 4days (IQR 4-7), respectively. A total of 14 patients experienced a high-grade complication (Clavien-Dindo ≥3) within 30days of surgery, and 8 were readmitted. The most common 30-day complication was sepsis, which affected 13% (4/31) of patients. At 90days postsurgery, the readmission rate was 32% (10/31), most commonly for sepsis. Three patients required reoperation within 90days, including one patient who required CU revision due to stomal ischemia. One patient died within this time frame from causes unrelated to bladder cancer. CONCLUSION In a comorbid, relatively elderly bladder cancer cohort undergoing RC, the use of CU was associated with expeditious surgery and postoperative recovery. CU represents an option for urinary diversion in high-risk patients undergoing RC. Higher rate of postoperative ureteral obstruction can be pre-emptively addressed with chronic stent placement.
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Affiliation(s)
| | | | - Mihai G Dumbrava
- Mayo Clinic Medical Scientist Training Program, Mayo Clinic Alix School of Medicine and Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN
| | | | - Prabin Thapa
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Robert Tarrell
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | - Paras Shah
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN
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Zhao X, Wan X, Gu C, Gao S, Yin J, Wang L, Quan L. Association between Red Blood Cell Distribution Width and Short-Term Mortality in Patients with Paralytic Intestinal Obstruction: Retrospective Data Analysis Based on the MIMIC-III Database. Emerg Med Int 2023; 2023:6739136. [PMID: 37908808 PMCID: PMC10615582 DOI: 10.1155/2023/6739136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 11/10/2022] [Accepted: 11/26/2022] [Indexed: 11/02/2023] Open
Abstract
Objective Elevated red cell distribution (RDW) has been reported to be associated with mortality in patients with acute pancreatitis and cholecystitis admitted to the intensive care unit (ICU). However, evidence for the relationship between RDW and paralytic intestinal obstruction is lacking. Therefore, the article aims to investigate the relationship between RDW and 28-day mortality of the patients with paralytic intestinal obstruction. Patients and Methods. This is a single-center retrospective study. Based on a particular screening criterion, 773 patients with paralytic intestinal obstruction were selected from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Indicators of the first 24 h into the ICU were used to analyze the relationship between RDW and 28-day death from paralytic intestinal obstruction by Kaplan-Meier (K-M) analysis, logistic regression analysis, and stratification analysis. Results The curve fitting exhibited a nonlinear relationship. The K-M curve showed that groups with higher RDW values had lower survival rates. The logistic regression analysis revealed that RDW increased with 28-day mortality in patients with paralytic intestinal obstruction in the fully adjusted model. In the fully adjusted model, OR value and 95% CI from the second to the third quantiles compared to the first quartile (reference group) were 1.89 (1.04, 3.44) and 3.29 (1.82, 5.93), respectively. The results of stratified analysis of each layer had the same trend as those of regression analysis, and the interaction results were not significant. Conclusion Elevated RDW was associated with increased 28-day mortality from paralytic intestinal obstruction in the ICU. This study can help to further explore the relationship between RDW and death in patients with paralytic intestinal obstruction.
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Affiliation(s)
- Xuelian Zhao
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan 250013, Shandong Province, China
| | - Xinhuan Wan
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan 250013, Shandong Province, China
| | - Chao Gu
- Department of Anorectal, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, Shandong Province, China
| | - Shanyu Gao
- Department of Anorectal, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, Shandong Province, China
| | - Jiahui Yin
- School of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250013, Shandong Province, China
| | - Lizhu Wang
- Department of Anorectal, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, Shandong Province, China
| | - Longfang Quan
- Department of Anorectal, China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing 100091, China
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Nakamura M, Tsuru I, Izumi T, Ono A, Inoue Y, Muraki Y, Yamada Y, Tsuji Y, Watanabe J, Fujimura M, Kihara S, Naito A, Shiratori T, Amakawa R, Inatsu H, Yoshimatsu T, Kashiwagi M, Fukuda A, Morikawa T, Kusakabe M, Suzuki M, Kameyama S, Kume H, Shiga Y. Advantages of enhanced recovery after surgery program in robot-assisted radical cystectomy. Sci Rep 2023; 13:16237. [PMID: 37758782 PMCID: PMC10533885 DOI: 10.1038/s41598-023-43489-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/25/2023] [Indexed: 09/29/2023] Open
Abstract
Radical cystectomy is a gold-standard treatment for muscle-invasive bladder cancer. We recently introduced robot-assisted radical cystectomy (RARC) with perioperative enhanced recovery after surgery (ERAS). The medical records of patients with bladder cancer who underwent open radical cystectomy (ORC) or RARC/ERAS at NTT Medical Center Tokyo were retrospectively reviewed to compare the surgical outcomes, hospital stay, and medical costs between groups. Multidisciplinary full ERAS items were provided for the RARC/ERAS group. The median estimated blood losses in the ORC and RARC/ERAS groups were 650 and 100 mL, and the median operative times were 312 and 445 min, respectively. In addition, the median times to liquid food intake in these groups were 6 and 0 days, the median times to first flatus and first defecation were 2 and 1 day, and 3 and 1.5 days, respectively. The rates of postoperative ileus in the ORC and RARC/ERAS groups were 27.5% and 4.5%, and the median postoperative hospital stays was 26.5 and 12 days, respectively. Medical costs excluding surgery were significantly lower in the RARC/ERAS group. In conclusion, RARC/ERAS represents a safe treatment option for muscle-invasive bladder cancer with decreased perioperative complications and lower medical costs.
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Affiliation(s)
- Masaki Nakamura
- Department of Urology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan.
| | - Ibuki Tsuru
- Department of Urology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan
| | - Taro Izumi
- Department of Urology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan
| | - Akihiro Ono
- Department of Urology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan
| | - Yasushi Inoue
- Department of Urology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan
| | - Yasuko Muraki
- Information System Group, NTT Medical Center Tokyo, Tokyo, Japan
- Critical Pathway Committee, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yumi Yamada
- Critical Pathway Committee, NTT Medical Center Tokyo, Tokyo, Japan
- Nursing Department, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yuko Tsuji
- Nutrition Department, NTT Medical Center Tokyo, Tokyo, Japan
| | - Junko Watanabe
- Department of Rehabilitation, NTT Medical Center Tokyo, Tokyo, Japan
| | | | - Shunsuke Kihara
- Operating Department, NTT Medical Center Tokyo, Tokyo, Japan
| | - Akihiro Naito
- Department of Urology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Taichi Shiratori
- Department of Urology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Ryo Amakawa
- Department of Urology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan
| | - Hiroki Inatsu
- Department of Urology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan
| | - Tadashi Yoshimatsu
- Department of Urology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan
| | | | - Akira Fukuda
- Department of Rehabilitation, NTT Medical Center Tokyo, Tokyo, Japan
| | - Teppei Morikawa
- Department of Diagnostic Pathology, NTT Medical Center Tokyo, Tokyo, Japan
| | | | - Motofumi Suzuki
- Department of Urology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | | | - Haruki Kume
- Department of Urology, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoshiyuki Shiga
- Department of Urology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan
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Nordkamp S, Creemers DMJ, Glazemakers S, Ketelaers SHJ, Scholten HJ, van de Calseijde S, Nieuwenhuijzen GAP, Tolenaar JL, Crezee HW, Rutten HJT, Burger JWA, Bloemen JG. Implementation of an Enhanced Recovery after Surgery Protocol in Advanced and Recurrent Rectal Cancer Patients after beyond Total Mesorectal Excision Surgery: A Feasibility Study. Cancers (Basel) 2023; 15:4523. [PMID: 37760492 PMCID: PMC10526990 DOI: 10.3390/cancers15184523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION The implementation of an Enhanced Recovery After Surgery (ERAS) protocol in patients with locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) has been deemed unfeasible until now because of the heterogeneity of this disease and low caseloads. Since evidence and experience with ERAS principles in colorectal cancer care are increasing, a modified ERAS protocol for this specific group has been developed. The aim of this study is to evaluate the implementation of a tailored ERAS protocol for patients with LARC or LRRC, requiring beyond total mesorectal excision (bTME) surgery. METHODS Patients who underwent a bTME for LARC or LRRC between October 2021 and December 2022 were prospectively studied. All patients were treated in accordance with the ERAS LARRC protocol, which consisted of 39 ERAS care elements specifically developed for patients with LARC and LRRC. One of the most important adaptations of this protocol was the anaesthesia procedure, which involved the use of total intravenous anaesthesia with intravenous (iv) lidocaine, iv methadone, and iv ketamine instead of epidural anaesthesia. The outcomes showed compliance with ERAS care elements, complications, length of stay, and functional recovery. A follow-up was performed at 30 and 90 days post-surgery. RESULTS Seventy-two patients were selected, all of whom underwent bTME for either LARC (54.2%) or LRRC (45.8%). Total compliance with the adjusted ERAS protocol was 73.6%. Major complications were present in 12 patients (16.7%), and the median length of hospital stay was 9 days (IQR 6.0-14.0). Patients who received multimodal anaesthesia (75.0%) stayed in the hospital for a median of 7.0 days (IQR 6.8-15.5). These patients received fewer opioids on the first three postoperative days than patients who received epidural analgesia (p < 0.001). CONCLUSIONS The implementation of the ERAS LARRC protocol seemed successful according to its compliance rate of >70%. Its complication rate was substantially reduced in comparison with the literature. Multimodal anaesthesia is feasible in beyond TME surgery with promising effects on recovery after surgery.
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Affiliation(s)
- Stefi Nordkamp
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands (G.A.P.N.)
- Department of GROW, School for Oncology and Reproduction, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Davy M. J. Creemers
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands (G.A.P.N.)
| | - Sofie Glazemakers
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands (G.A.P.N.)
| | - Stijn H. J. Ketelaers
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands (G.A.P.N.)
| | - Harm J. Scholten
- Department of Anaesthesiology, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands
| | | | | | - Jip L. Tolenaar
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands (G.A.P.N.)
| | - Hendi W. Crezee
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands (G.A.P.N.)
| | - Harm J. T. Rutten
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands (G.A.P.N.)
- Department of GROW, School for Oncology and Reproduction, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Jacobus W. A. Burger
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands (G.A.P.N.)
| | - Johanne G. Bloemen
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands (G.A.P.N.)
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Nagahawatte ND, Avci R, Paskaranandavadivel N, Cheng LK. Evaluation of Pacing Parameters to Induce Contractions in the Small Intestine. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083505 DOI: 10.1109/embc40787.2023.10340534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Postoperative ileus and chronic intestinal pseudo-obstruction are intestinal motility disorders that can compromise bowel function resulting in a significant reduction in quality of life and prolonged hospital stays. While medication and nutritional support provides relief for some patients, a significant patient population remains untreated. Therefore, alternative treatment options are required. A novel framework that enables small intestine pacing and video mapping of the contractile response was developed. Pacing pulse parameters (pulse-period: 2.7, 10 s, pulse-width: 100, 400 ms, and pulse-amplitude: 4, 6, 8 mA) were systematically varied to investigate the effect of pacing on the small intestine contractility. The contractile response was quantified by computing the strain of the intestinal diameter at the pacing site. The framework was applied in vivo on porcine jejunal loops (n=4) where segmental contractions were induced in response to pacing pulses. Strain increased with increasing pulse-amplitude and pulse-width, while pacing at a period of 2.7 s elicited higher contractile strains compared to pacing at a period of 10 s at all settings (e.g., -0.18 ± 0.06 vs 0.12 ± 0.06 at 8 mA, 400 ms). For a pulse-width of 100 ms, the contractile strain continued to increase with increasing pulse-amplitude, while the induced strain was comparable for all pulse-amplitudes when paced with high pulse-width (400 ms). Therefore, pacing is an effective tool in modulating the intensity of segmental contractions.Clinical Relevance- Different pacing parameters can define contraction intensity and frequency in the small intestine. This is of therapeutic potential for treating motility disorders such as post-operative ileus and chronic intestinal pseudo-obstruction.
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Burkhard JP, Jardot F, Furrer MA, Engel D, Beilstein C, Wuethrich PY. Opioid-Free Anesthesia for Open Radical Cystectomy Is Feasible and Accelerates Return of Bowel Function: A Matched Cohort Study. J Clin Med 2023; 12:jcm12113657. [PMID: 37297852 DOI: 10.3390/jcm12113657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
The aim of this study was to evaluate the feasibility of opioid-free anesthesia (OFA) in open radical cystectomy (ORC) with urinary diversion and to assess the impact on recovery of gastrointestinal function. We hypothesized that OFA would lead to earlier recovery of bowel function. A total of 44 patients who underwent standardized ORC were divided into two groups (OFA group vs. control group). In both groups, patients received epidural analgesia (OFA group: bupivacaine 0.25%, control group: bupivacaine 0.1%, fentanyl 2 mcg/mL, and epinephrine 2 mcg/mL). The primary endpoint was time to first defecation. Secondary endpoints were incidence of postoperative ileus (POI) and incidence of postoperative nausea and vomiting (PONV). The median time to first defecation was 62.5 h [45.8-80.8] in the OFA group and 118.5 h [82.6-142.3] (p < 0.001) in the control group. With regard to POI (OFA group: 1/22 patients (4.5%); control group: 2/22 (9.1%)) and PONV (OFA group: 5/22 patients (22.7%); control group: 10/22 (45.5%)), trends but no significant results were found (p = 0.99 and p = 0.203, respectively). OFA appears to be feasible in ORC and to improve postoperative functional gastrointestinal recovery by halving the time to first defecation compared with standard fentanyl-based intraoperative anesthesia.
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Affiliation(s)
- John-Patrik Burkhard
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
- Limmat Cleft- and Craniofacial Centre Zurich, 8005 Zurich, Switzerland
| | - François Jardot
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Marc A Furrer
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
- Department of Urology, Solothurner Spitäler AG, Kantonsspital Olten, Bürgerspital Solothurn, 4500 Solothurn, Switzerland
- Department of Urology, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Dominique Engel
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Christian Beilstein
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Patrick Y Wuethrich
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
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11
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Preliminary In Vitro Assessment of Decellularized Porcine Descending Aorta for Clinical Purposes. J Funct Biomater 2023; 14:jfb14030141. [PMID: 36976065 PMCID: PMC10058365 DOI: 10.3390/jfb14030141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Conduit substitutes are increasingly in demand for cardiovascular and urological applications. In cases of bladder cancer, radical cystectomy is the preferred technique: after removing the bladder, a urinary diversion has to be created using autologous bowel, but several complications are associated with intestinal resection. Thus, alternative urinary substitutes are required to avoid autologous intestinal use, preventing complications and facilitating surgical procedures. In the present paper, we are proposing the exploitation of the decellularized porcine descending aorta as a novel and original conduit substitute. After being decellularized with the use of two alternative detergents (Tergitol and Ecosurf) and sterilized, the porcine descending aorta has been investigated to assess its permeability to detergents through methylene blue dye penetration analysis and to study its composition and structure by means of histomorphometric analyses, including DNA quantification, histology, two-photon microscopy, and hydroxyproline quantification. Biomechanical tests and cytocompatibility assays with human mesenchymal stem cells have been also performed. The results obtained demonstrated that the decellularized porcine descending aorta preserves its major features to be further evaluated as a candidate material for urological applications, even though further studies have to be carried out to demonstrate its suitability for the specific application, by performing in vivo tests in the animal model.
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12
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Nagahawatte ND, Cheng LK, Avci R, Angeli-Gordon TR, Paskaranandavadivel N. Systematic review of small intestine pacing parameters for modulation of gut function. Neurogastroenterol Motil 2023; 35:e14473. [PMID: 36194179 PMCID: PMC10078404 DOI: 10.1111/nmo.14473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/22/2022] [Accepted: 09/12/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE The efficacy of conventional treatments for severe and chronic functional motility disorders remains limited. High-energy pacing is a promising alternative therapy for patients that fail conventional treatment. Pacing primarily regulates gut motility by modulating rhythmic bio-electrical events called slow waves. While the efficacy of this technique has been widely investigated on the stomach, its application in the small intestine is less developed. This systematic review was undertaken to summarize the status of small intestinal pacing and evaluate its efficacy in modulating bowel function through preclinical research studies. METHODS The literature was searched using Scopus, PubMed, Ovid, Cochrane, CINAHL, and Google Scholar. Studies investigating electrophysiological, motility, and/or nutrient absorption responses to pacing were included. A critical review of all included studies was conducted comparing study outcomes against experimental protocols. RESULTS The inclusion criteria were met by 34 publications. A range of pacing parameters including amplitude, pulse width, pacing direction, and its application to broad regional small intestinal segments were identified and assessed. Out of the 34 studies surveyed, 20/23 studies successfully achieved slow-wave entrainment, 9/11 studies enhanced nutrient absorption and 21/27 studies modulated motility with pacing. CONCLUSION Small intestine pacing shows therapeutic potential in treating disorders such as short bowel syndrome and obesity. This systematic review proposes standardized protocols to maximize research outcomes and thereby translate to human studies for clinical validation. The use of novel techniques such as high-resolution electrical, manometric, and optical mapping in future studies will enable a mechanistic understanding of pacing.
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Affiliation(s)
- Nipuni D Nagahawatte
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Leo K Cheng
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Surgery, Vanderbilt University, Nashville, Tennessee, USA.,Riddet Institute Centre of Research Excellence, Palmerston North, New Zealand
| | - Recep Avci
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Timothy R Angeli-Gordon
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Surgery, University of Auckland, Auckland, New Zealand
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13
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Casarin M, Todesco M, Sandrin D, Romanato F, Bagno A, Morlacco A, Dal Moro F. A Novel Hybrid Membrane for Urinary Conduit Substitutes Based on Small Intestinal Submucosa Coupled with Two Synthetic Polymers. J Funct Biomater 2022; 13:jfb13040222. [PMID: 36412863 PMCID: PMC9680483 DOI: 10.3390/jfb13040222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Among the urinary tract's malignancies, bladder cancer is the most frequent one: it is at the tenth position of most common cancers worldwide. Currently, the gold standard therapy consists of radical cystectomy, which results in the need to create a urinary diversion using a bowel segment from the patient. Nevertheless, due to several complications associated with bowel resection and anastomosis, which significantly affect patient quality of life, it is becoming extremely important to find an alternative solution. In our recent work, we proposed the decellularized porcine small intestinal submucosa (SIS) as a candidate material for urinary conduit substitution. In the present study, we create SIS-based hybrid membranes that are obtained by coupling decellularized SIS with two commercially available polycarbonate urethanes (Chronoflex AR and Chronoflex AR-LT) to improve SIS mechanical resistance and impermeability. We evaluated the hybrid membranes by means of immunofluorescence, two-photon microscopy, FTIR analysis, and mechanical and cytocompatibility tests. The realization of hybrid membranes did not deteriorate SIS composition, but the presence of polymers ameliorates the mechanical behavior of the hybrid constructs. Moreover, the cytocompatibility tests demonstrated a significant increase in cell growth compared to decellularized SIS alone. In light of the present results, the hybrid membrane-based urinary conduit can be a suitable candidate to realize a urinary diversion in place of an autologous intestinal segment. Further efforts will be performed in order to create a cylindrical-shaped hybrid membrane and to study its hydraulic behavior.
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Affiliation(s)
- Martina Casarin
- Department of Surgery, Oncology and Gastroenterology, Giustiniani 2, 35128 Padua, Italy
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, Via N. Giustiniani 2, 35128 Padua, Italy
| | - Martina Todesco
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, Via N. Giustiniani 2, 35128 Padua, Italy
- Department of Industrial Engineering, University of Padua, Via Marzolo 9, 35131 Padua, Italy
| | - Deborah Sandrin
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, Via N. Giustiniani 2, 35128 Padua, Italy
- Department of Physics and Astronomy ‘G. Galilei’, University of Padova, Via Marzolo 8, 35131 Padua, Italy
| | - Filippo Romanato
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, Via N. Giustiniani 2, 35128 Padua, Italy
- Department of Physics and Astronomy ‘G. Galilei’, University of Padova, Via Marzolo 8, 35131 Padua, Italy
- Laboratory of Optics and Bioimaging, Institute of Pediatric Research Città della Speranza, 35127 Padua, Italy
| | - Andrea Bagno
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, Via N. Giustiniani 2, 35128 Padua, Italy
- Department of Industrial Engineering, University of Padua, Via Marzolo 9, 35131 Padua, Italy
- Correspondence:
| | - Alessandro Morlacco
- Department of Surgery, Oncology and Gastroenterology, Giustiniani 2, 35128 Padua, Italy
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, Via N. Giustiniani 2, 35128 Padua, Italy
| | - Fabrizio Dal Moro
- Department of Surgery, Oncology and Gastroenterology, Giustiniani 2, 35128 Padua, Italy
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, Via N. Giustiniani 2, 35128 Padua, Italy
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14
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Kalemci S, Ergun KE, Kizilay F, Yildiz B, Simsir A. Analysis of risk factors of abdominal wound dehiscence after radical cystectomy. Rev Assoc Med Bras (1992) 2022; 68:1553-1557. [DOI: 10.1590/1806-9282.220220564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/03/2022] [Indexed: 11/29/2022] Open
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15
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Preliminary Results of ERAS Protocol in a Single Surgeon Prospective Case Series. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091234. [PMID: 36143911 PMCID: PMC9501830 DOI: 10.3390/medicina58091234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/18/2022] [Accepted: 09/01/2022] [Indexed: 11/25/2022]
Abstract
Background and Objectives: The aim was to compare the intra and postoperative outcomes between the Enhanced Recovery After Surgery (ERAS) protocol versus the standard of care protocol (SCP) in patients who underwent radical cystectomy performed by a single surgeon. Materials and Methods: A retrospective comparative study was conducted including patients who underwent radical cystectomy from 2017 to 2020. Length of stay (LOS), incidence of ileus, early postoperative complications, and number of re-hospitalizations within 30 days were considered as primary comparative outcomes of the study. Results: Data were collected for 91 patients who underwent cystectomy, and 70 and 21 patients followed the SCP and ERAS protocol, respectively. The mean age of the patients was 70.6 (SD 9.5) years. Although there was a statistically significant difference in time to flatus (TTF) [3 (2.7−3) vs. 1 (1−2 IQR) days, p < 0.001, in the SC hospital and in the ERAS center respectively], no difference was reported in time to first defecation (TTD) [5 (4−6) vs. 4 (3−5.8), p = 0.086 respectively]. The median LOS in the SCP group was 12 (IQR 11−13) days vs. 9 (IQR 8−13 p = 0.024). In the postoperative period, patients reported 22 complications (37% in SCP and 42.8% in ERAS group, p = 0.48). Conclusions: The study reveals how even partial adherence to the ERAS protocols leads to similar outcomes when compared to SCP. As a single surgeon series, our study confirmed the role of surgeons in reducing complications and improving surgical outcomes.
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16
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Sui C, Tao L, Bai C, Shao L, Miao J, Chen K, Wang M, Hu Q, Wang F. Molecular and cellular mechanisms underlying postoperative paralytic ileus by various immune cell types. Front Pharmacol 2022; 13:929901. [PMID: 35991871 PMCID: PMC9385171 DOI: 10.3389/fphar.2022.929901] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Postoperative ileus (POI) is a well-known complication following gut manipulation or surgical trauma, leading to an impaired gut motility and prolonged postoperative recovery time. Few current therapeutic strategies can prevent POI, and this disorder remains to be a major clinical challenge for patients undergoing surgery. Comprehensive understanding of cellular and molecular mechanisms related to the pathogenesis of POI stimulates the discovery of more promising targets for treatment. POI is closely associated with a series of inflammatory events within the bowel wall, and as key components of inflammatory mechanisms, different types of immune cells, including macrophages, dendritic cells, and T lymphocytes, play significant roles during the development of POI. A variety of immune cells are recruited into the manipulation sites after surgery, contributing to early inflammatory events or impaired gut motility. Our review intends to summarize the specific relationship between different immune cells and POI, mainly focusing on the relevant mechanisms underlying this disorder.
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Affiliation(s)
- Chao Sui
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Medical School of Nanjing University, Nanjing, China
| | - Liang Tao
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Chunhua Bai
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Medical School of Nanjing University, Nanjing, China
| | - Lihua Shao
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ji Miao
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Kai Chen
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Medical School of Nanjing University, Nanjing, China
| | - Meng Wang
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- *Correspondence: Meng Wang, ; Qiongyuan Hu, ; Feng Wang,
| | - Qiongyuan Hu
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Medical School of Nanjing University, Nanjing, China
- *Correspondence: Meng Wang, ; Qiongyuan Hu, ; Feng Wang,
| | - Feng Wang
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- *Correspondence: Meng Wang, ; Qiongyuan Hu, ; Feng Wang,
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17
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Lee AY, Allen JC, Teoh JYC, Kang SH, Patel MI, Muto S, Yang CK, Hatakeyama S, Zhang R, Kijvikai K, Chen H, Ohyama C, Horie S, Chan ESY, Lee LS. Predicting perioperative outcomes of robot-assisted radical cystectomy: Data from the Asian Robot-Assisted Radical Cystectomy Consortium. Int J Urol 2022; 29:1002-1009. [PMID: 35613922 DOI: 10.1111/iju.14937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To report the perioperative outcomes of robot-assisted radical cystectomy and elucidate their risk factors. METHODS A review of the Asian Robot-Assisted Radical Cystectomy Consortium database from 2007 to 2020 was performed. The perioperative outcomes studied included complication rates, time to solid food intake, estimated blood loss, length of hospital stay, and 30-day readmission rates. RESULTS Of 568 patients, the overall complication rate was 49.2%, comprising major complications in 15.6%. Preoperative hydronephrosis was associated with an increased risk of major complications (odds ratio 3.27, 95% confidence interval 1.48-7.26, P = 0.004) while neoadjuvant chemotherapy was protective (odds ratio 0.46, 95% confidence interval 0.25-0.84, P = 0.012). The median time to solid food intake was 4 days (interquartile range 3-7) and smoking was a risk factor (odds ratio 4.28, 95% confidence interval 2.36-7.79, P < 0.001) for prolonged time to solid food intake. Median length of hospital stay was 13 days (interquartile range 9-19), and diabetes mellitus (odds ratio 1.66, 95% confidence interval 1.08-2.56, P = 0.021), neoadjuvant chemotherapy (odds ratio 2.21, 95% confidence interval 1.46-3.33, P < 0.001), and orthotopic bladder substitute creation (odds ratio 2.82, 95% confidence interval 1.90-4.18, P < 0.001) were independent risk factors for prolonged length of hospital stay. The 30-day readmission rate was 23.4% and higher in those with bilateral hydronephrosis (odds ratio 4.58, 95% confidence interval 1.97-10.65, P < 0.001) and orthotopic bladder substitute creation (odds ratio 1.87, 95% confidence interval 1.16-3.02, P = 0.010). CONCLUSIONS There are preoperative conditions which are significant risk factors for adverse perioperative outcomes in robot-assisted radical cystectomy. Most are potentially modifiable and can direct strategies to reduce surgical morbidity related to this major oncological procedure.
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Affiliation(s)
- Alvin Yuanming Lee
- Department of Urology, Sengkang General Hospital, Singapore.,Department of Urology, Singapore General Hospital, Singapore
| | | | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China.,European Association of Urology Young Academic Urologists, Urothelial Carcinoma Working Group (EAU-YAU)
| | - Seok-Ho Kang
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Manish I Patel
- Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Satoru Muto
- Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Cheng-Kuang Yang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ruiyun Zhang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kittinut Kijvikai
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Haige Chen
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shigeo Horie
- Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Eddie Shu-Yin Chan
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Lui-Shiong Lee
- Department of Urology, Sengkang General Hospital, Singapore.,Department of Urology, Singapore General Hospital, Singapore
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18
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Babakhanlou R, Larkin K, Hita AG, Stroh J, Yeung SC. Stoma-related complications and emergencies. Int J Emerg Med 2022; 15:17. [PMID: 35534817 PMCID: PMC9082897 DOI: 10.1186/s12245-022-00421-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractStoma creations are common procedures in surgical specialties. They can be created either as a temporary or a permanent measure. Despite advancements in surgical technique and stoma care, complications are common. Patients experiencing stoma-related complications often present to the emergency department. Emergency physicians are not expected to be stoma experts, yet they are often the first point of contact for patients experiencing stoma-related complications. Accordingly, emergency physicians should be familiar with the types of stomas and complications and emergencies associated with them so that they can appropriately address the problems related to stomas. This article will provide a review of emergencies and complications associated with ileostomies, colostomies, and urostomies.
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19
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Atkins CS, Tubog TD, Schaffer SK. Chewing Gum After Radical Cystectomy With Urinary Diversion for Recovery of Intestinal Function: A Systematic Review and Meta-Analysis. J Perianesth Nurs 2022; 37:467-473. [PMID: 35272926 DOI: 10.1016/j.jopan.2021.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/24/2021] [Accepted: 10/09/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE To evaluate the efficacy of chewing in the recovery of intestinal function after radical cystectomy. DESIGN Systematic review and meta-analysis. METHODS Following the PRISMA statement, PubMed, CINAHL, Google Scholar, Cochrane Review Database, EMBASE, Scopus, and grey literature were searched for evidence. FINDINGS The analysis included 2 trials with 100 patients. Compared to placebo, chewing gum resulted in faster recovery of bowel function (mean difference [MD], -16.00; 95% confidence interval [CI], -18.67 to -13.32; P < .00001). In addition, chewing gum decreased the time to flatus (MD, -14.81; 95% CI, -22.14 to -7.47; P < .0001), but did not reduced the length of stay (MD, 0.97; 95% CI, -1.23 to 3.18; P = .39) and the incidence of postoperative ileus (risk ratio, 0.67; 95% CI, 0.20-2.23; P = .51). The quality of evidence is low due to imprecision and suspected publication bias. CONCLUSIONS Chewing gum appears to be an inexpensive intervention to improve the return of bowel function in patients undergoing radical cystectomy.
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20
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Porcine Small Intestinal Submucosa (SIS) as a Suitable Scaffold for the Creation of a Tissue-Engineered Urinary Conduit: Decellularization, Biomechanical and Biocompatibility Characterization Using New Approaches. Int J Mol Sci 2022; 23:ijms23052826. [PMID: 35269969 PMCID: PMC8910833 DOI: 10.3390/ijms23052826] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 02/06/2023] Open
Abstract
Bladder cancer (BC) is among the most common malignancies in the world and a relevant cause of cancer mortality. BC is one of the most frequent causes for bladder removal through radical cystectomy, the gold-standard treatment for localized muscle-invasive and some cases of high-risk, non-muscle-invasive bladder cancer. In order to restore urinary functionality, an autologous intestinal segment has to be used to create a urinary diversion. However, several complications are associated with bowel-tract removal, affecting patients' quality of life. The present study project aims to develop a bio-engineered material to simplify this surgical procedure, avoiding related surgical complications and improving patients' quality of life. The main novelty of such a therapeutic approach is the decellularization of a porcine small intestinal submucosa (SIS) conduit to replace the autologous intestinal segment currently used as urinary diversion after radical cystectomy, while avoiding an immune rejection. Here, we performed a preliminary evaluation of this acellular product by developing a novel decellularization process based on an environmentally friendly, mild detergent, i.e., Tergitol, to replace the recently declared toxic Triton X-100. Treatment efficacy was evaluated through histology, DNA, hydroxyproline and elastin quantification, mechanical and insufflation tests, two-photon microscopy, FTIR analysis, and cytocompatibility tests. The optimized decellularization protocol is effective in removing cells, including DNA content, from the porcine SIS, while preserving the integrity of the extracellular matrix despite an increase in stiffness. An effective sterilization protocol was found, and cytocompatibility of treated SIS was demonstrated from day 1 to day 7, during which human fibroblasts were able to increase in number and strongly organize along tissue fibres. Taken together, this in vitro study suggests that SIS is a suitable candidate for use in urinary diversions in place of autologous intestinal segments, considering the optimal results of decellularization and cell proliferation. Further efforts should be undertaken in order to improve SIS conduit patency and impermeability to realize a future viable substitute.
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21
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Zennami K, Sumitomo M, Hasegawa K, Kozako M, Takahara K, Nukaya T, Takenaka M, Fukaya K, Ichino M, Fukami N, Sasaki H, Kusaka M, Shiroki R. Risk factors for postoperative ileus after robot-assisted radical cystectomy with intracorporeal urinary diversion. Int J Urol 2022; 29:553-558. [PMID: 35229914 DOI: 10.1111/iju.14839] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 02/14/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the risk factors for postoperative ileus in patients who underwent robot-assisted radical cystectomy with intracorporeal urinary diversion. METHODS We retrospectively analyzed 78 patients with bladder cancer who underwent robot-assisted radical cystectomy with intracorporeal urinary diversion at Fujita Health University between 2011 and 2021. Baseline characteristics and perioperative outcomes were compared between the cohorts with and without ileus. Logistic regression analysis was used to identify the risk factors for postoperative ileus. RESULTS Out of the 78 patients included in this study, 20 (25.6%) developed postoperative ileus. The ileus cohort was associated with a significantly lower Geriatric-8 score (P = 0.003) and a higher rate of previous abdominal/pelvic surgery (P = 0.04) compared with those of the nonileus cohort. Significantly longer intestinal tract reconstruction time, hospital stay, time to mobilization, fluid intake, solid intake, flatus, and stool were observed in the ileus cohort. According to the results of the logistic regression analysis, the Geriatric-8 sum (P = 0.009), time to mobilization (P = 0.03), and time to fluid intake (P = 0.004) were independent predictors of postoperative ileus. In the model predicting postoperative ileus, the area under the receiver operating characteristic curve was 0.716, and the cutoff value of the Geriatric-8 sum was 13. CONCLUSIONS Early mobilization and fluid intake and low Geriatric-8 scores were significant risk factors for postoperative ileus. Preoperative Geriatric-8 evaluation is a useful tool for predicting postoperative ileus. Comprehensive enhanced recovery after surgery, including key components, may help bowel recovery and prevent subsequent ileus.
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Affiliation(s)
- Kenji Zennami
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kyu Hasegawa
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masaki Kozako
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Takuhisa Nukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masashi Takenaka
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kosuke Fukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Manabu Ichino
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Naohiko Fukami
- Department of Urology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Hitomi Sasaki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Mamoru Kusaka
- Department of Urology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
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22
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Lee G, Patel HV, Srivastava A, Ghodoussipour S. Updates on enhanced recovery after surgery for radical cystectomy. Ther Adv Urol 2022; 14:17562872221109022. [PMID: 35844831 PMCID: PMC9280843 DOI: 10.1177/17562872221109022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/07/2022] [Indexed: 12/24/2022] Open
Abstract
Enhanced Recovery after Surgery (ERAS) is a multimodal pathway that provides evidence-based guidance for improving perioperative care and outcomes in patients undergoing surgery. In 2013, the ERAS society released its original guidelines for radical cystectomy (RC) for bladder cancer (BC), adopting much of its supporting data from colorectal literature. In the last decade, growing interest in ERAS has increased RC-specific ERAS research, including prospective randomized controlled trials (RCTs). Collective data suggest ERAS contributes to improved complication rates, decreased hospital length-of-stay, and/or time to bowel recovery. Various institutions have adopted modified versions of the ERAS pathway, yet there remains a lack of consensus on the efficacy of specific ERAS items and standardization of the protocol. In this review, we summarize updated evidence and practice patterns of ERAS pathways for RC since the introduction of the original 2013 guidelines. Novel target interventions, including use of immunonutrition, prehabilitation, alvimopan, and methods of local analgesia are reviewed. Finally, we discuss barriers to implementing and future steps in advancing the ERAS movement.
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Affiliation(s)
- Grace Lee
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Hiren V Patel
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Arnav Srivastava
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Saum Ghodoussipour
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street, Room 4561, New Brunswick, NJ 08903, USA
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Zlakishvili B, Sela HY, Tankel J, Ioscovich A, Rotem R, Grisaru-Granovsky S, Rottenstreich M. Post-cesarean ileus: An assessment of incidence, risk factors and outcomes. Eur J Obstet Gynecol Reprod Biol 2021; 269:55-61. [PMID: 34968875 DOI: 10.1016/j.ejogrb.2021.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/30/2021] [Accepted: 12/11/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To estimate the frequency of post cesarean paralytic ileus and to identify associated risk factors and outcomes. STUDY DESIGN A retrospective cohort study of woman who underwent cesarean delivery between 2005 and 2019. All parturients who had cesarean delivery were stratified and compared according to whether or not they were diagnosed with a paralytic ileus. Women were excluded if they had an intestinal injury or repair during the cesarean or if they suffered from a post cesarean mechanical bowel obstruction diagnosed during re-laparotomy. Basic demographics, obstetric history, current delivery characteristics, re-suturing indications and outcomes were obtained and analyzed. Univariate analyses were followed by a multivariate analysis (adjusted Odds Ratio (aORs) ; [95% Confidence Interval]). RESULTS A total of 23,486 women met the inclusion and exclusion criteria of which 135 (0.6%) were diagnosed with paralytic ileus whilst 23,347 (99.4%) did not and served as the control group. Multivariate analysis revealed that an estimated intra-operative blood loss ≥ 1000 ml was the most significant risk factor for post cesarean paralytic ileus (aOR 2.27 (1.18-4.36)), followed by multifetal gestation (aOR 2.08 (1.24-3.51)), corporeal uterine incision (aOR 1.97 (1.07-3.63)), use of topical hemostatic agents (aOR 1.78 (1.19-2.66)) and increasing maternal age (aOR 1.78 (1.19-2.66)). Regarding maternal outcomes, post cesarean paralytic ileus was associated with higher rates of postpartum hemorrhage (44.4% vs. 13.4%, p < 0.01), transfusion of blood products (23.7% vs. 3.9%, p < 0.01), post-cesarean exploratory laparotomy (4.4% vs. 0.1%, p < 0.01) and prolonged hospital stay (32.6% vs. 5.2%, p < 0.01). CONCLUSION In our population, whilst post cesarean paralytic ileus is infrequent, when it occurs it is associated with increased short-term maternal morbidity.
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Affiliation(s)
- Barak Zlakishvili
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Hen Y Sela
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - James Tankel
- Department of General Surgery, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Alexander Ioscovich
- Department of Anesthesiology, Shaare Zedek Medical Center, Affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel.
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel; Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
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Knoerlein J, Heinrich S, Kaufmann K, Schultze-Seemann W, Baar W, Kalbhenn J. Epidural analgesia is associated with earlier gastrointestinal transit after radical cystectomy but does not reduce the incidence of postoperative ileus: A retrospective cohort study. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211051587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To compare the effect of combined epidural thoracic analgesia and general anaesthesia (CEGA) in radical cystectomy (RC) with respect to the return of gastrointestinal passage, the incidence of paralytic postoperative ileus (POI) compared to general anaesthesia (GA) only. Patients and methods: We conducted a retrospective review using the electronic medical records of 236 patients who underwent RCs between July 2011 and September 2018 at the Medical Center – University of Freiburg. Results: A CEGA was administered to 202 patients, while 34 patients received only GA. The baseline characteristics of patients with and without CEGA showed no significant differences. CEGA will decrease the time required for return of gastrointestinal transit as measured by time to first defecation by about 13 hours. In the first 90 days after surgery, 82 (34.7%) patients had a POI. There was no significant difference between complications in the CEGA and GA groups. Conclusion: A CEGA accelerates the return of the gastrointestinal transit but does not reduce the incidence of postoperative ileus. Level of evidence: 2b
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Affiliation(s)
- Julian Knoerlein
- Department of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Sebastian Heinrich
- Department of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Kai Kaufmann
- Department of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Wolfgang Schultze-Seemann
- Department of Urology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Wolfgang Baar
- Department of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Johannes Kalbhenn
- Department of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Xue X, Wang D, Ji Z, Xie Y. Risk factors of postoperative ileus following laparoscopic radical cystectomy and developing a points-based risk assessment scale. Transl Androl Urol 2021; 10:2397-2409. [PMID: 34295726 PMCID: PMC8261424 DOI: 10.21037/tau-21-112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/22/2021] [Indexed: 11/06/2022] Open
Abstract
Background Postoperative ileus (POI) is one of the most common complications after laparoscopic radical cystectomy (LRC). Albeit its high incidence, its risk factors are obscure, and few studies have attempted to explore them. Meanwhile, risk-assessing tools for predicting its happening are lacking. Methods Clinical data of 197 patients who underwent LRC between March 2014 and October 2019 were retrospectively collected. All cases of POI were identified and double-checked. Data pertaining to the following categories were extracted as well: patients' general characteristics, preoperative laboratory tests results and preparations, intraoperative and postoperative general items, pathological results. The correlation between candidate risk factors and ileus was analyzed by multivariable binary logistic regression. Clinical and pathophysiological explanations for those results were explored. Finally, a points-based prediction model was developed and validated for predicting the happening of POI. Results A total of 63 out of 197 patients (31.98%) suffered from POI. Multivariate logistic regression analysis showed chronic constipation, increased dosage of laxative, elevated preoperative serum creatinine level, delayed postoperative ambulation, intestine-related urine derivations were statistically significant for developing POI (P<0.05). No significant differences were found between POI and age, gender, body mass index (BMI), antibiotics, hypertension, diabetes, smoking, hard-drinking, preoperative hemoglobin level, preoperative albumin level, history of previous abdominal surgery, surgery time, intraoperative blood loss, blood transfusion, tumor size, lymph nodes yields, TNM staging and intensive care unit hospitalization. An external cohort had been used for testing the validation of the assessment scale, and the results were promising. Conclusions Early recognition is of great importance in protecting vulnerable patients from developing POI, knowing the above-mentioned risk factors and using the assessment scale should help to screen them better. Cases from diverse backgrounds might contribute to a more accurate and complete scale.
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Affiliation(s)
- Xiaoqiang Xue
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing, China
| | - Dong Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing, China
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing, China
| | - Yi Xie
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing, China
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Maibom SL, Joensen UN, Poulsen AM, Kehlet H, Brasso K, Røder MA. Short-term morbidity and mortality following radical cystectomy: a systematic review. BMJ Open 2021; 11:e043266. [PMID: 33853799 PMCID: PMC8054090 DOI: 10.1136/bmjopen-2020-043266] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To study short-term (<90 days) morbidity and mortality following radical cystectomy (RC) for bladder cancer and identify modifiable risk factors associated with these. DESIGN Systematic review. METHODS The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and EMBASE were searched for relevant papers on 11 June 2019 and rerun on 27 May 2020. Studies reporting complications, reoperations, length of stay and mortality within 90 days were included. Studies were reviewed according to criteria from the Oxford Centre for Evidence-Based Medicine and the quality of evidence was assessed using the Newcastle-Ottawa Scale. RESULTS The search retrieved 1957 articles. Sixty-six articles were included. The quality of evidence was poor to good. Most studies were retrospective, and no randomised clinical trials were identified. Of included studies a median of 6 Martin criteria for reporting complications after surgery were fulfilled. The Clavien-Dindo classification for grading complications was most frequently used. The weighted overall complication rate after RC was 34.9% (range 28.8-68.8) for in-house complications, 39.0% (range 27.3-80.0) for 30-day complications and 58.5% (range 36.1-80.5) for 90-day complications. The most common types of complications reported were gastrointestinal (29.0%) and infectious (26.4%). The weighted mortality rate was 2.4% (range 0.9-4.7) for in-house mortality, 2.1% (0.0-3.7) for 30-day mortality and 4.7% (range 0.0-7.0) for 90-day mortality. Age and comorbidity were identified as the best predictors for complications following RC. CONCLUSION Short-term morbidity and mortality are high following RC. Reporting of complications is heterogeneous and the quality of evidence is generally low. There is a continuous need for randomised studies to address any intervention that can reduce morbidity and mortality following RC. PROSPERO REGISTRATION NUMBER 104937.
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Affiliation(s)
- Sophia Liff Maibom
- Department of Urology, Urological Research Unit, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Nordström Joensen
- Department of Urology, Urological Research Unit, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Alicia Martin Poulsen
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Henrik Kehlet
- Department of Clinical Medicine, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark
- Section for Surgical Pathophysiology, The Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Klaus Brasso
- Department of Urology, Urological Research Unit, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Martin Andreas Røder
- Department of Urology, Urological Research Unit, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark
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27
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Orthotopic Bladder Substitution. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Haywood S, Donahue TF, Bochner BH. Management of Common Complications After Radical Cystectomy, Lymph Node Dissection, and Urinary Diversion. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Pfister D, Niegisch G. [Bladder cancer - complications related to urinary diversion]. Aktuelle Urol 2020; 51:456-462. [PMID: 32462641 DOI: 10.1055/a-1134-6642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Even today, radical cystectomy with urinary diversion is one of the most complicated procedures in uro-oncology. Particularly in the long-term course, but also perioperatively, problems caused by urinary diversion play a significant role.Perioperatively, gastrointestinal problems such as an ileus, but also infections and early complications of the different anastomoses are most important. While ileus and perioperative infections can usually be treated conservatively, failure of the intestinal or ureteroileal anastomoses require regular surgical revisions.In the long-term follow-up, scarring can lead to chronic obstruction of urinary flow and, in the case of continental urinary diversions, to stone formation. These complications, as well as parastomal hernias in patients with poor conduits, may require further therapy. Functional bowel disorders may impair patients' quality of life significantly.Improved preoperative preparation and accompanying measures during the inpatient stay can significantly reduce non-surgical complications.Cystectomy with therapy-associated morbidity is a classical example of when surgery must be performed at specialised centers to reduce complications perioperatively as well as in follow-up.
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Affiliation(s)
- David Pfister
- Klinik für Urologie, Uro-Onkologie, Roboter-assistierte und spezielle urologische Chirurgie Universitätsklinik Köln
| | - Günter Niegisch
- Heinrich-Heine-Universität, Medizinische Fakultät, Klinik für Urologie, Düsseldorf
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30
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Forbes CM, Chehroudi AC, Mannas M, Bisaillon A, Hong T, So AI, Mayson K, Black PC. Defining postoperative ileus and associated risk factors in patients undergoing radical cystectomy with an Enhanced Recovery After Surgery (ERAS) program. Can Urol Assoc J 2020; 15:33-39. [PMID: 32745002 DOI: 10.5489/cuaj.6546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Postoperative ileus (POI) is a common complication of radical cystectomy (RC), occurring in 1.6-23.5% of cases. It is defined heterogeneously in the literature. POI increases hospital length of stay and postoperative morbidity. Factors such as age, epidural use, length of procedure, and blood loss may impact POI. In this study, we aimed to evaluate risk factors that contribute to POI in a cohort of patients managed with a comprehensive Enhanced Recovery After Surgery (ERAS) protocol. METHODS A retrospective review of consecutive patients who underwent RC from March 2015 to December 2016 at Vancouver General Hospital was performed. POI was defined a priori as insertion of nasogastric tube for nausea or vomiting, or failure to advance to a solid diet by the seventh postoperative day. To illustrate heterogeneity in previous studies, we also evaluated POI using other previously reported definitions in the RC literature. The influence of potential risk factors for POI, including patient comorbidities, American Society of Anesthesiologists score, gender, age, prior abdominal surgery or radiation, length of operation, diversion type, extent of lymph node dissection, removal date of analgesic catheter, blood loss, and fluid administration volume was analyzed. RESULTS Thirty-six (27%) of 136 patients developed POI. Using other previously reported definitions for POI, the incidence ranged from <1-51%. Node-positive status and age at surgery were associated with POI on univariate analysis but not multivariable analysis. CONCLUSIONS A large range of POI incidence was observed using previously published definitions of POI. We advocate for a standardized definition of POI when evaluating RC outcomes. POI occurs frequently even with a comprehensive ERAS protocol, suggesting that additional measures are needed to reduce the rate of POI.
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Affiliation(s)
- Connor M Forbes
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ali Cyrus Chehroudi
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Miles Mannas
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Andrea Bisaillon
- Department of Surgical Services, University of British Columbia, Vancouver, BC, Canada
| | - Tracey Hong
- Department of Surgical Services, University of British Columbia, Vancouver, BC, Canada
| | - Alan I So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kelly Mayson
- Department of Anesthesiology University of British Columbia, Vancouver, BC, Canada
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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31
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Huang JTH, Cole AP, Mossanen M, Preston MA, Wang Y, Kibel AS, Chung BI, Huang WJ, Chang SL. Alvimopan Is Associated With a Reduction in Length of Stay and Hospital Costs for Patients Undergoing Radical Cystectomy. Urology 2020; 140:115-121. [DOI: 10.1016/j.urology.2020.01.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/28/2019] [Accepted: 01/06/2020] [Indexed: 12/14/2022]
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Refaai K, Sharafeldin MA, Elabbady A, Sameh W, Thurairaja R, Nair R, Dasgupta P, Khan MS, Mohamed E. Perioperative Outcomes of Open Retrograde Extraperitoneal Versus Intracorporeal Robot-assisted Radical Cystoprostatectomy in Men: A Dual-center Comparative Study. Clin Genitourin Cancer 2019; 18:e315-e323. [PMID: 31911120 DOI: 10.1016/j.clgc.2019.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/08/2019] [Accepted: 12/09/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION We compared retrograde extraperitoneal open radical cystoprostatectomy (REORC) and robot-assisted radical cystoprostatectomy with intracorporeal diversion (iRARC) and have reported the early perioperative outcomes. PATIENTS AND METHODS REORC and iRARC were each performed at a different tertiary high-volume center in 2 countries. Men aged ≥ 18 years with precystectomy clinical stage T1-T3 disease were included. Patients with previous major pelvic and/or intra-abdominal surgery, those who had undergone previous pelvic and/or abdominal irradiation, women, and patients with clinical stage T4 disease were excluded. All cases were managed according to a standardized enhanced recovery after surgery protocol, and all the patients had undergone ileal conduit urinary diversion. Bowel recovery was one of the main endpoints; thus, the intervals to passing flatus, tolerating oral feeding, and bowel opening were determined. The operative time, estimated blood loss, intraoperative complications, length of hospital stay, postcystectomy tumor type, stage, margin status, lymph node yield, and 30- and 90-day complications were analyzed. RESULTS We performed a retrospective analysis of prospectively collected data from October 2016 to December 2018 of 99 patients, 50 of whom had undergone REORC and 49 iRARC. The demographic data and preoperative parameters were comparable between the 2 groups. REORC resulted in a significantly shorter mean operative time (P < .001), significantly greater mean estimated blood loss (P < .001), and greater percentage of patients requiring blood transfusion (98% vs. 12.24%). No significant differences in the length of stay were observed (P = .412). The rate of prolonged postoperative ileus was 16% and 18.4% in the REORC and iRARC groups, respectively (P = .3). Differences in the interval to passing flatus, tolerating solid oral intake, and bowel opening were not statistically significant between the 2 groups (P = .423, P = .770, and P = .700, respectively). No statistically significant difference was observed in the postcystectomy pathologic outcomes and overall and major complications rates at 30 and 90 days. CONCLUSION REORC resulted in quicker bowel recovery and a shorter length of stay compared with conventional open procedures, with advantages comparable to those realized with iRARC. Thus, REORC can be adopted as the preferred open approach at institutions without surgical robots available.
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Affiliation(s)
- Khaled Refaai
- Department of Urology, Alexandria University, Alexandria, Egypt.
| | | | - Ahmed Elabbady
- Department of Urology, Alexandria University, Alexandria, Egypt
| | - Wael Sameh
- Department of Urology, Alexandria University, Alexandria, Egypt
| | | | - Rajesh Nair
- Department of Urology, Guy's Hospital, London, United Kingdom
| | - Prokar Dasgupta
- Department of Urology, Guy's Hospital, London, United Kingdom
| | | | - Elsayedamr Mohamed
- Department of Bioinformatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt
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Trafford AM, Parisi R, Kontopantelis E, Griffiths CEM, Ashcroft DM. Association of Psoriasis With the Risk of Developing or Dying of Cancer: A Systematic Review and Meta-analysis. JAMA Dermatol 2019; 155:1390-1403. [PMID: 31617868 PMCID: PMC6802036 DOI: 10.1001/jamadermatol.2019.3056] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/09/2019] [Indexed: 12/19/2022]
Abstract
Importance The risk of cancer developing in people with psoriasis has raised some concern, with little clarity regarding differentiation in risk according to psoriasis severity. Objective To conduct a systematic review and meta-analysis of observational studies on the risk of cancer incidence and mortality in people with psoriasis. Data Sources Six electronic databases (MEDLINE, Embase, MEDLINE in Process, Cochrane Central Register, Web of Science, and LILACS [Literatura Latino-Americana e do Caribe em Ciências da Saúde]) were searched from inception to November 15, 2017, for eligible studies. Study Selection Cohort and case-control studies that provided estimates of the risk of cancer incidence or cancer mortality associated with psoriasis were included. Data Extraction and Synthesis Data were extracted relating to study design, study population, and risk estimates. Study-specific estimates of the relative risk (RR) were combined using a random-effects model. Heterogeneity was quantified using the I2 statistic. Data were analyzed from April 9, 2018, through February 22, 2019. Main Outcomes and Measures Pooled RR estimates for cancer incidence and cancer mortality for psoriasis cohorts compared with people without psoriasis. Results A total of 58 unique studies were included, with quality varying for the incidence and the mortality studies. Severe psoriasis (RR, 1.22; 95% CI, 1.08-1.39 [9 studies]) and all severities of psoriasis (RR, 1.18; 95% CI, 1.06-1.31 [7 studies]) were associated with an increased risk of cancer (overall), and associations were found for a range of site-specific cancers, including colon (RR, 1.18 [95% CI, 1.03-1.35]), colorectal (RR, 1.34 [95% CI, 1.06-1.70]), kidney (RR, 1.58 [95% CI, 1.11-2.24]), laryngeal (RR, 1.79 [95% CI, 1.06-3.01]), liver (RR, 1.83 [95% CI, 1.28-2.61]), lymphoma (RR, 1.40 [95% CI, 1.24-1.57]), non-Hodgkin lymphoma (RR, 1.28 [95% CI, 1.15-1.43]), keratinocyte cancers (RR, 1.71 [95% CI, 1.08-2.71]), esophageal (RR, 2.05 [95% CI, 1.04-4.07]), oral cavity (RR, 2.80 [95% CI, 1.99-3.93]), and pancreatic (RR, 1.41 [95% CI, 1.16-1.73]). Overall cancer mortality risk was higher in patients with severe psoriasis (RR, 1.22; 95% CI, 1.08-1.38 [4 studies]). Specifically, liver (RR, 1.43 [95% CI, 1.09-1.88]), esophageal (RR, 2.53 [95% CI, 1.87-3.41]), and pancreatic (RR, 1.31 [95% CI, 1.02-1.69]) cancer mortality were found to be elevated in those with severe psoriasis. The heterogeneity of estimates was often very high despite stratification. Marked attenuation of risk was found in those studies that adjusted estimates for smoking, alcohol consumption, and obesity. Conclusions and Relevance In this study, people with psoriasis appeared to have an increased risk of cancer incidence and cancer-related mortality involving a range of site-specific cancers. Future research examining specific lifestyle factors, treatments, and the inflammatory processes that contribute to psoriasis may help provide additional information on the underlying mechanisms for the apparent increased cancer risk.
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Affiliation(s)
- Alex M Trafford
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom
| | - Rosa Parisi
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom
| | - Evangelos Kontopantelis
- School of Health Sciences, National Institute for Health Research (NIHR) School of Primary Care Research, Division of Population Health, Faculty of Biology, Medicine, and Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
| | - Christopher E M Griffiths
- Dermatology Centre, NIHR Manchester Biomedical Research Centre, Faculty of Biology, Medicine, and Health, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Darren M Ashcroft
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom
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Giannarini G, Crestani A, Inferrera A, Rossanese M, Subba E, Novara G, Ficarra V. Impact of enhanced recovery after surgery protocols versus standard of care on perioperative outcomes of radical cystectomy: a systematic review and meta-analysis of comparative studies. MINERVA UROL NEFROL 2019; 71:309-323. [PMID: 31241271 DOI: 10.23736/s0393-2249.19.03376-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Among the measures taken in the recent years to reduce the morbidity and improve functional recovery after radical cystectomy (RC), the optimization of perioperative care pathways is gaining a prominent role. The aim of this systematic review of the literature with meta-analysis is to assess the impact of enhanced recovery after surgery (ERAS) protocols vs. standard of care on perioperative outcomes of patients undergoing RC. EVIDENCE ACQUISITION A systematic review with meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. MEDLINE, SCOPUS and Web of Science databases were searched. Only comparative studies evaluating the impact of ERAS protocols vs. standard of care on intraoperative and postoperative outcomes of patients undergoing RC were included. Cumulative analysis was conducted using Review Manager v.5.3 software. Statistical heterogeneity was tested using the χ2 Test, and a P value <0.10 was used to indicate heterogeneity. Random-effects and fixed-effects models were used as appropriate depending on heterogeneity status. EVIDENCE SYNTHESIS A total of 27 studies were included, namely 3 randomized and 24 non-randomized controlled studies, resulting in 4712 patients, 2690 (57%) participants to some ERAS protocol and 2022 (43%) controls receiving standard of care. A number of primary and secondary outcome measures were assessed in the original studies. Pooled data showed that ERAS protocols were associated with significantly faster recovery of bowel function, faster return to regular diet and shorter hospital stay with no increase in 30-day and 90-day major complication, mortality or readmission rates compared to standard of care. The magnitude of benefit of the various ERAS protocols tested had, however, a non-negligible inter-study variability. CONCLUSIONS This systematic review with meta-analysis of comparative studies showed that ERAS protocols applied to patients undergoing RC enabled a faster recovery of bowel function, a faster return to regular diet and a shorter hospital stay with no increase in major complication or readmission rate compared to standard perioperative care. RC with ERAS protocols should be considered the new standard of care.
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Affiliation(s)
- Gianluca Giannarini
- Unit of Urology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy
| | - Alessandro Crestani
- Unit of Urology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy
| | - Antonino Inferrera
- Section of Urology, Gaetano Barresi Department of Human and Pediatric Pathology, University of Messina, Messina, Italy
| | - Marta Rossanese
- Section of Urology, Gaetano Barresi Department of Human and Pediatric Pathology, University of Messina, Messina, Italy
| | - Enrica Subba
- Section of Urology, Gaetano Barresi Department of Human and Pediatric Pathology, University of Messina, Messina, Italy
| | - Giacomo Novara
- Department of Surgery, Oncology and Gastroenterology, Clinic of Urology, University of Padua, Padua, Italy
| | - Vincenzo Ficarra
- Section of Urology, Gaetano Barresi Department of Human and Pediatric Pathology, University of Messina, Messina, Italy -
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Nazzani S, Bandini M, Preisser F, Mazzone E, Marchioni M, Tian Z, Stubinski R, Clementi MC, Saad F, Shariat SF, Montanari E, Briganti A, Carmignani L, Karakiewicz PI. Postoperative paralytic ileus after major oncological procedures in the enhanced recovery after surgery era: A population based analysis. Surg Oncol 2019; 28:201-207. [PMID: 30851901 DOI: 10.1016/j.suronc.2019.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 12/03/2018] [Accepted: 01/27/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) protocols have been developed and implemented as of 2001 and may have significantly reduced several complication types including paralytic ileus. However, no formal analyses targeted paralytic ileus rates after contemporary major surgical oncology procedures. We examined temporal trends of paralytic ileus following ten major oncological surgical procedures. The effect of paralytic ileus on length of stay (LOS) and total hospital charges was examined. Univariable and multivariable linear and logistic regression analyses were used. METHODS Between 2003 and 2013, we retrospectively identified patients, who underwent prostatectomy, colectomy, cystectomy, mastectomy, gastrectomy, hysterectomy, nephrectomy, oophorectomy, lung resection or pancreatectomy within the Nationwide Inpatient Sample. A total of 3 431 602 patients were included in our analyses. Annual paralytic ileus rate differences after major oncological surgical procedures were evaluated using linear regression. Multivariable logistic regression analyses were used to test for paralytic ileus rates determinants, as well as on the effect of paralytic ileus rates on LOS and hospital charges. RESULTS Paralytic ileus rates ranged from 0.1% (mastectomy) to 23.2% (cystectomy) after ten examined major oncological surgical procedures. Overall annual paralytic ileus rates did not change [estimated annual percentage change (EAPC)+0.1%, p = 0.7]. Multivariable logistic regression derived predicted probabilities (PP) of paralytic ileus were highest for cystectomy (PP: 26.1%) and colectomy (PP: 17.15%) and were lowest for lung resection (PP: 2.22%) and mastectomy (PP: 0.16%). In analyses predicting LOS above the 75th percentile, paralytic ileus effect after mastectomy (OR: 14.66) and prostatectomy (OR: 13.21) ranked, as highest and second highest respectively. In analyses predicting hospital charges above the 75th percentile, paralytic ileus effect after mastectomy (OR: 2.21) and oophorectomy (OR: 1.99) ranked as highest and second highest respectively. CONCLUSIONS Despite implementation of ERAS protocols paralytic ileus rates have not decreased over time. Gastrointestinal procedures are among the highest contributors of paralytic ileus. Moreover, procedures with short LOS represent the strongest relative contributors to LOS increases and increases in hospitalization costs.
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Affiliation(s)
- Sebastiano Nazzani
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de L'Université de Montréal (CR-CHUM), Institut du Cancer de Montréal, Montréal, Québec, Canada; Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy.
| | - Marco Bandini
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de L'Université de Montréal (CR-CHUM), Institut du Cancer de Montréal, Montréal, Québec, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy, Vita-Salute San Raffaele University, Milan, Italy
| | - Felix Preisser
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de L'Université de Montréal (CR-CHUM), Institut du Cancer de Montréal, Montréal, Québec, Canada; Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elio Mazzone
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de L'Université de Montréal (CR-CHUM), Institut du Cancer de Montréal, Montréal, Québec, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele Marchioni
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, SS Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Robert Stubinski
- Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Maria Chiara Clementi
- Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de L'Université de Montréal (CR-CHUM), Institut du Cancer de Montréal, Montréal, Québec, Canada
| | | | - Emanuele Montanari
- Department of Urology, IRCCS Fondazione Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy, Vita-Salute San Raffaele University, Milan, Italy
| | - Luca Carmignani
- Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de L'Université de Montréal (CR-CHUM), Institut du Cancer de Montréal, Montréal, Québec, Canada
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Leow JJ, Bedke J, Chamie K, Collins JW, Daneshmand S, Grivas P, Heidenreich A, Messing EM, Royce TJ, Sankin AI, Schoenberg MP, Shipley WU, Villers A, Efstathiou JA, Bellmunt J, Stenzl A. SIU–ICUD consultation on bladder cancer: treatment of muscle-invasive bladder cancer. World J Urol 2019; 37:61-83. [DOI: 10.1007/s00345-018-2606-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/12/2018] [Indexed: 01/09/2023] Open
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Kuo SC, Mu PF, Chang LY, Chou SS, Lee MY, Su JY, Shih CF, Curia M. Effectiveness of coffee for postoperative ileus in patients following abdominal surgery: a systematic review protocol. ACTA ACUST UNITED AC 2018; 16:2072-2079. [PMID: 30439742 DOI: 10.11124/jbisrir-2017-003686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The purpose of this systematic review is to critically appraise, synthesize and present the best available evidence concerning the effects of coffee on postoperative ileus following abdominal surgery. The review will consider the effect of coffee and decaffeinated coffee on recovering gastrointestinal function, time to first bowel movement, time to first flatus, time to tolerance of solid food, postoperative complications and length of hospital stay.
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Affiliation(s)
- Shu-Chen Kuo
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Fan Mu
- Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan.,Taiwan Evidence Based Practice Centre: a Joanna Briggs Centre of Excellence
| | - Li-Yin Chang
- Department of Nursing, China Medical University Hospital, Taichung City, Taiwan
| | - Shin-Shang Chou
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Mei-Yin Lee
- Department of Nursing, National Taipei University of Nursing and Health Science, Taipei, Taiwan
| | - Jui-Yuan Su
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chiung-Fen Shih
- Department of Nursing, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Marianne Curia
- Department of Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan
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Effectiveness of hyaluronic acid/carboxymethylcellulose in preventing adhesive bowel obstruction after laparoscopic radical cystectomy. Asian J Surg 2018; 42:394-400. [PMID: 30266466 DOI: 10.1016/j.asjsur.2018.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/22/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND/OBJECTIVE Adhesive bowel obstruction is one of the most frequent complications after radical cystectomy, prolonging hospital stay and fasting period and increasing medical expenses. This study evaluated the effectiveness of hyaluronic acid/carboxymethylcellulose (HA/CMC) in preventing adhesive bowel obstruction after laparoscopic radical cystectomy. METHODS Randomized, controlled, single-blinded study was performed. Of 76 patients who underwent laparoscopic radical cystectomy for bladder cancer, 38 received HA/CMC instillation and 38 did not. The primary endpoint was the rate of postoperative adhesive bowel obstruction. The secondary endpoint was the rate of other postoperative outcomes. RESULTS None of the patients who received HA/CMC instillation experienced postoperative adhesive bowel obstructions, compared with six (15.79%) patients in the control group (p = 0.025). Of the six patients with ileus, two underwent adhesiolysis. There were no significant differences between the two groups in other postoperative outcomes. CONCLUSION HA/CMC instillation during laparoscopic radical cystectomy may reduce the incidence of postoperative adhesive bowel obstruction without adverse effects.
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40
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Ghanaat M, Winer AG, Sjoberg DD, Poon BY, Kashan M, Tin AL, Sfakianos JP, Cha EK, Donahue TF, Dalbagni G, Herr HW, Bochner BH, Vickers AJ, Donat SM. Comparison of Postradical Cystectomy Ileus Rates Using GIA-80 Versus GIA-60 Intestinal Stapler Device. Urology 2018; 122:121-126. [PMID: 30244117 DOI: 10.1016/j.urology.2018.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/24/2018] [Accepted: 09/11/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the impact on recovery of bowel function using an 80 mm versus 60 mm gastrointestinal anastomosis (GIA) stapler following radical cystectomy and urinary diversion (RC/UD) for bladder cancer. METHODS We identified 696 patients using a prospectively maintained RC/UD database from January 2006 to November 2010. Two nonrandomized consecutive cohorts were compared. Patients between January 2006- and December 2007 (n = 180) were treated using a 60 mm GIA stapler, and 331 patients between January 2008 and December 2010 were subject to an 80 mm GIA stapler. All patients were treated on the same standardized postoperative recovery pathway. After accounting for baseline patient and perioperative characteristics, using a multivariable logistic regression model, we directly compared rates of postoperative ileus using a standardized definition. RESULTS Of 511 evaluable patients, ileus was observed in 32% (57/180) for 60 mm GIA versus 33% (110/331) for the 80 mm GIA. Preoperative renal function, age, gender, body mass index, and type of diversion were comparable between cohorts. On multivariate analysis, stapler size was not significantly associated with the development of ileus (GIA-60 vs GIA-80: OR 1.11; 95% CI 0.75, 1.66; P = .6). Positive fluid balance was associated with an increased risk (P = .019) and female sex a decreased risk (P = .008) of developing ileus compared to patients with negative fluid balance. CONCLUSION The size of the intestinal bowel anastomosis (GIA 80 mm vs 60 mm) does not independently impact the time to bowel recovery following RC/UD.
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Affiliation(s)
- Mazyar Ghanaat
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Andrew G Winer
- SUNY Downstate College of Medicine and Kings County Hospital Center, New York, NY
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bing Ying Poon
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mahyar Kashan
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; SUNY Downstate College of Medicine and Kings County Hospital Center, New York, NY
| | - Amy L Tin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Eugene K Cha
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Timothy F Donahue
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Guido Dalbagni
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Harry W Herr
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bernard H Bochner
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - S Machele Donat
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Cao L, Wang T, Lin J, Jiang Z, Chen Q, Gan H, Chen Z. Effect of Yikou-Sizi powder hot compress on gastrointestinal functional recovery in patients after abdominal surgery: Study protocol for a randomized controlled trial. Medicine (Baltimore) 2018; 97:e12438. [PMID: 30235726 PMCID: PMC6160149 DOI: 10.1097/md.0000000000012438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Postoperative gastrointestinal dysfunction (PGD) is a common complication of patients who have undergone surgery. The clinical manifestations cause great discomfort to postoperative patients and can severely affect postoperative recovery. However, although various pharmacologic agents have been explored for several years, success has been limited. Because some commonly used drugs have caused adverse reactions and because abdominal surgery patients generally cannot consume food or medication during the perioperative period, we were prompted to try an external Chinese medicine treatment method. Yikou-Sizi powder hot compress is an efficient therapy in our hospital, but there is a lack of rigorous studies to certify the safety and effectiveness of its external use to improve gastrointestinal motility. This study aimed to introduce the clinical trial design and test the ability of Yikou-Sizi powder hot compress treatment to accelerate gastrointestinal functional recovery after abdominal surgery. METHODS This study is a randomized controlled clinical trial. The participants will undergo laparoscopic colorectal cancer surgery and laparoscopic total hysterectomy. The primary outcome measure will be the gastrointestinal functional evaluation index, including the time to first passage of flatus, first defecation, first normal bowel sounds, and first consumption of liquid/semigeneral diet foods. According to good clinical practice (GCP), we will evaluate the clinical efficacy and safety of Yikou-Sizi powder hot compress and objectively study the acting mechanism of ghrelin. This pilot trial will be a standard, scientific, and clinical study designed to evaluate the effect of Yikou-Sizi powder hot compress for the recovery of gastrointestinal function after surgery and determine its overall safety. DISCUSSION This is the first study to describe the use of Yikou-Sizi powder hot compress to accelerate the recovery of gastrointestinal function after abdominal surgery. The study is designed as a randomized, controlled, clinical, large sample size and pilot trial. Evaluation will consist of combining the primary outcome measures with secondary outcome measures to ensure the objectivity and scientific validity of the study. Due to the observational design and the limited follow-up period, it is not possible to evaluate to what extent the connection between the observed improvement and the interventions represents a causal relationship. Efficient comparison between groups will be analyzed by chi-square test.
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Affiliation(s)
- Lixing Cao
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Tao Wang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jinxuan Lin
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhi Jiang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Qicheng Chen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Huachan Gan
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Zhiqiang Chen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine
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Song W, Yoon HS, Kim KH, Yoon H, Chung WS, Sim BS, Lee DH. Role of bowel suspension technique to prevent early intestinal obstruction after radical cystectomy with ileal orthotopic neobladder: A retrospective cohort study. Int J Surg 2018; 55:9-14. [PMID: 29723678 DOI: 10.1016/j.ijsu.2018.04.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/15/2018] [Accepted: 04/26/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We investigate the impact of the bowel suspension technique (BST) on paralytic ileus and early intestinal obstruction (≤60days) after radical cystectomy (RC) with ileal orthotopic neobladder (IONB). METHODS We retrospectively reviewed 310 patients who underwent RC with IONB for bladder cancer between 2001 and 2017. After forming the Studer IONB, ileal continuity was restored by side-to-side stapled anastomosis. Then, we suspended stapled anastomotic portion of bowel on the posterior peritoneum not to fall into the pelvic cavity. The clinicopathologic characteristics of patients were examined and the onset of paralytic ileus and early intestinal obstruction were identified. Logistic regression analysis was used to identify predictors associated with paralytic ileus and early intestinal obstruction. RESULTS Of the 310 total patients, paralytic ileus and early intestinal obstruction were identified in 100 (32.3%) and 15 (4.8%), respectively. When patients were divided into two groups (BST [-] vs. BST [+]), the rates of paralytic ileus were not significantly different (64/205[31.2%] vs. 36/105[34.3%], P = 0.585). However, early intestinal obstruction that required surgical treatment was significantly decreased (14/205[6.8%] vs. 1/105[1.0%], P = 0.024). On multivariate analysis, older age was commonly associated with paralytic ileus and early intestinal obstruction (P = 0.008 and P = 0.016). BST was inversely associated with early intestinal obstruction (95% CI: 0.01-0.85, P = 0.034), but not related to paralytic ileus. CONCLUSION BST significantly reduced early intestinal obstruction without increasing paralytic ileus after RC with IONB. BST could be used as useful technique to reduce severe bowel complications.
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Affiliation(s)
- Wan Song
- Department of Urology, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Hyun Suk Yoon
- Department of Urology, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Kwang Hyun Kim
- Department of Urology, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Hana Yoon
- Department of Urology, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Woo Sik Chung
- Department of Urology, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Bong Suk Sim
- Department of Urology, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Dong Hyeon Lee
- Department of Urology, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
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Postoperative management of radical cystectomy. Review of the evidence on the prevention and treatment of urological complications. Actas Urol Esp 2018; 42:143-151. [PMID: 28587844 DOI: 10.1016/j.acuro.2017.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 04/28/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION AND OBJECTIVES This review article focuses on the prevention and management of the most common postoperative urological complications of radical cystectomy. We reviewed the current literature and conducted an analysis of frequency, prevention and treatment of complications. ACQUISITION OF EVIDENCE We conducted a search on Medline to identify original articles, literature reviews and editorials focusing on the urological complications of radical cystectomy during the first 90 days after surgery. We identified those series that included more than 100 patients. SYNTHESIS OF THE EVIDENCE The literature regarding the prevention and treatment of complications after cystectomy is in general retrospective and nonstandardised. The level of evidence is generally low, and it is difficult to make evidence-based recommendations. CONCLUSIONS Progress has been made in recent years in reducing mortality and preventing the complications of cystectomy. The most common complications are gastrointestinal, for which significant efforts have been made to implement ERAS and Fast Track protocols. The complications that can most significantly change patients' quality of life are urinary stoma.
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Effects of Nonsteroidal Anti-Inflammatory Drugs as Patient Controlled Analgesia on Early Bowel Function Recovery after Radical Cystectomy. Sci Rep 2018; 8:4658. [PMID: 29545530 PMCID: PMC5854570 DOI: 10.1038/s41598-018-22677-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/26/2018] [Indexed: 01/31/2023] Open
Abstract
This study aimed to evaluate the effects of ketorolac, a commonly used non-steroidal anti-inflammatory drug (NSAID) as patient controlled intravenous infusion analgesia (PCIA) for the patients underwent radical cystectomy (RC) due to bladder cancer regarding post-operational indices of recovery. Total seventy patients who underwent radical cystectomy for the treatment of bladder cancer were included in the study. 35 patients received ketorolac as PCIA (NSAIDS group) and 35 patients had morphine infusion as PCIA (morphine group). Pain intensity, bowel function recovery and length of hospital stay were evaluated. Early postoperative complications were analyzed according to surgical types (robot RC vs. open RC). Demographics were similar between two groups. NSAIDS group showed a significant reduction in postoperative vomiting (p = 0.001), time to flatus (p = 0.028), time to first bowel movement (p = 0.001) and time to first clear liquid diet (p = 0.002) compared with morphine group. No statistically significant differences were observed between two groups regarding length of hospitalization, and postoperative complications. For 48 hours after RC, pain relief was slightly better in morphine group (p < 0.001). Both open RC and robot RC cases showed significantly better bowel function recovery with NSAIDS groups. Ketorolac as PCIA is relatively effective in pain management with better gastrointestinal recovery after RC.
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Hirobe M, Tanaka T, Shindo T, Ichihara K, Hotta H, Takahashi A, Kato R, Yanase M, Matsukawa M, Itoh N, Kunishima Y, Taguchi K, Horita H, Masumori N. Complications within 90 days after radical cystectomy for bladder cancer: results of a multicenter prospective study in Japan. Int J Clin Oncol 2018; 23:734-741. [PMID: 29442282 DOI: 10.1007/s10147-018-1245-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/18/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE We prospectively evaluated the 90-day postoperative mortality and morbidity of open radical cystectomy by using a standardized reporting methodology. Additionally, we assessed the preoperative characteristics to determine risk factors for major complications. METHODS This multicenter prospective study included 185 consecutive patients undergoing open radical cystectomy from October 2010 through March 2014. Postoperative complications within 90 days were recorded and graded according to the modified Clavien-Dindo classification. RESULTS Totally, 328 postoperative complications were observed in 149 patients (80.5%). Of these events, 73 (22.2%) were high grade (≥ Grade III), and developed in 46 patients (24.9%). Three patients (1.6%) died postoperatively. Urinary tract infection, wound complications, and paralytic ileus were common complications that occurred in 55 (29.7%), 42 (22.7%) and 41 (22.2%) patients, respectively. Ureteroenteric stricture was diagnosed in 13 of the 151 patients (8.6%) undergoing intestinal urinary diversion. Emergency room visits were required for 13 patients (7.0%) and readmission after discharge was needed for 36 (19.5%). A body mass index ≥ 25 kg/m2, smoking history and Charlson Comorbidity Index ≥ 2 were independent risk factors for high-grade complications, and their odds ratios (95% confidence intervals) were 2.357 (1.123-4.948), 2.843 (1.225-6.596) and 3.025 (1.390-6.596), respectively. CONCLUSIONS Open radical cystectomy is associated with a high incidence of postoperative complications. Most, however, are of low grade. Our results suggest that obesity, a smoking history, and increasing comorbidity are risk factors for major complications.
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Affiliation(s)
- Megumi Hirobe
- Department of Urology, Sapporo Medical University School of Medicine, Minami-1 Nishi-16, Chuo-ku, Sapporo, 060-8543, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Toshiaki Tanaka
- Department of Urology, Sapporo Medical University School of Medicine, Minami-1 Nishi-16, Chuo-ku, Sapporo, 060-8543, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Tetsuya Shindo
- Department of Urology, Sapporo Medical University School of Medicine, Minami-1 Nishi-16, Chuo-ku, Sapporo, 060-8543, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Koji Ichihara
- Department of Urology, Sapporo Medical University School of Medicine, Minami-1 Nishi-16, Chuo-ku, Sapporo, 060-8543, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Hiroshi Hotta
- Division of Urology, Asahikawa Red Cross Hospital, Asahikawa, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Atsushi Takahashi
- Division of Urology, Hakodate Goryoukaku Hospital, Hakodate, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Ryuichi Kato
- Division of Urology, Muroran City General Hospital, Muroran, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Masahiro Yanase
- Division of Urology, Sunagawa City Medical Center, Sunagawa, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Masanori Matsukawa
- Division of Urology, Takikawa Municipal Hospital, Takikawa, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Naoki Itoh
- Division of Urology, NTT-East Corporation Sapporo Medical Center, Sapporo, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Yasuharu Kunishima
- Division of Urology, Hokkaido Social Work Association Obihiro Hospital, Obihiro, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Keisuke Taguchi
- Division of Urology, Oji General Hospital, Tomakomai, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Hiroki Horita
- Division of Urology, Hokkaido Saiseikai Otaru Hospital, Otaru, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Minami-1 Nishi-16, Chuo-ku, Sapporo, 060-8543, Japan. .,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan.
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Voskuilen CS, van de Putte EEF, der Hulst JBV, van Werkhoven E, de Blok WM, van Rhijn BWG, Horenblas S, Meijer RP. Short-term outcome after cystectomy: comparison of early oral feeding in an enhanced recovery protocol and feeding using Bengmark nasojejunal tube. World J Urol 2017; 36:221-229. [PMID: 29167985 PMCID: PMC5799347 DOI: 10.1007/s00345-017-2133-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/14/2017] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Cystectomy for bladder cancer is associated with a high risk of postoperative complications. Standardized perioperative protocols, such as enhanced recovery after surgery (ERAS) protocols, aim to improve postoperative outcome. Postoperative feeding strategies are an important part of these protocols. In this two-centre study, we compared complications and length of hospital stay (LOS) between an ERAS protocol with early oral nutrition and a protocol with early enteral feeding with a Bengmark nasojejunal tube. METHODS We retrospectively reviewed 154 consecutive patients who underwent cystectomy for bladder cancer in two hospitals (Hospital A and B) between 2014 and 2016. Hospital A uses an ERAS protocol (n = 45), which encourages early introduction of an oral diet. Hospital B uses a fast-track protocol comprising feeding with a Bengmark nasojejunal tube (Bengmark-protocol, n = 109). LOS and complications according to Clavien classification were compared between protocols. RESULTS Overall 30-day complication rates in the ERAS and Bengmark protocol were similar (64.4 and 67.0%, respectively; p = 0.463). The rate of postoperative ileus (POI) was significantly lower in the Bengmark protocol (11.9% vs. 34.4% in the ERAS protocol, p = 0.009). This association remained significant after adjustment for other variables (odds ratio 0.32, 95% confidence interval 0.11-0.96; p = 0.042). Median LOS did not differ significantly between protocols (10 days vs. 11 days in the ERAS and Bengmark protocols, respectively; p = 0.861). CONCLUSIONS Early oral nutrition in Hospital A was well tolerated. However, the Bengmark protocol was superior with respect to occurrence of POI. A prospective study may clarify whether the lower rate of POI was due to the use of early nasojejunal tube feeding or other reasons.
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Affiliation(s)
- C S Voskuilen
- Department of Urologic Oncology, University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands.,Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - E E Fransen van de Putte
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - J Bloos-van der Hulst
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - E van Werkhoven
- Department of Biometrics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - W M de Blok
- Department of Urologic Oncology, University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands
| | - B W G van Rhijn
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - S Horenblas
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - R P Meijer
- Department of Urologic Oncology, University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands. .,Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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47
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Sanderson JJ, Boysen SR, McMurray JM, Lee A, Stillion JR. The effect of fasting on gastrointestinal motility in healthy dogs as assessed by sonography. J Vet Emerg Crit Care (San Antonio) 2017; 27:645-650. [DOI: 10.1111/vec.12673] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/14/2016] [Accepted: 04/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Jillian J. Sanderson
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine; University of Calgary; Calgary Alberta Canada
| | - Søren R. Boysen
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine; University of Calgary; Calgary Alberta Canada
- Western Veterinary Specialist and Emergency Centre; Calgary Alberta Canada
| | - Jantina M. McMurray
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine; University of Calgary; Calgary Alberta Canada
| | - Albert Lee
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine; University of Calgary; Calgary Alberta Canada
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48
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Semerjian A, Milbar N, Kates M, Gorin MA, Patel HD, Chalfin HJ, Frank SM, Wu CL, Yang WW, Hobson D, Robertson L, Wick E, Schoenberg MP, Pierorazio PM, Johnson MH, Stimson CJ, Bivalacqua TJ. Hospital Charges and Length of Stay Following Radical Cystectomy in the Enhanced Recovery After Surgery Era. Urology 2017; 111:86-91. [PMID: 29032237 DOI: 10.1016/j.urology.2017.09.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/10/2017] [Accepted: 09/08/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To report our center's experience with enhanced recovery after surgery (ERAS) pathway for radical cystectomy (RC), specifically evaluating complications, LOS, 30- and 90-day readmissions, and hospital charges. Pathways of this type have been shown to decrease the length of stay (LOS) and postoperative ileus. However, concerns persist that ERAS is costly and increases readmissions. To date, limited studies have evaluated these concerns. MATERIALS AND METHODS Our ERAS protocol was implemented for RC in December 2015. Outcomes in ERAS patients were compared with those in RC patients from the time period before ERAS. Patients were excluded if they underwent concomitant nephroureterectomy. RESULTS Fifty-six consecutive ERAS patients were compared with 54 pre-ERAS patients. The median charge for index hospitalization was $31,090 in the ERAS group and $35,489 in the pre-ERAS group (P = .036). The median LOS was 5.0 days in the ERAS group and 8.5 days in the pre-ERAS group (P = < .001). The pre-ERAS group had a significantly increased use of nasogastric tube (13.8% vs 30.0%) and parenteral nutrition (6.9% vs 20.4%). The overall complication rate (including infectious, renal, deep vein thrombosis and pulmonary embolism, myocardial infarction and stroke, and respiratory and gastrointestinal-related complications) was similar between the 2 groups (51.7% in the ERAS group and 62.0% in the pre-ERAS group, P = .28). Thirty- and 90-day readmissions also remained similar (19.0% vs 14.8%, P = .55, and 31.0% vs 27.7%, P = .64). The most common readmission reason was infection, specifically urinary tract infection. CONCLUSION Implementation of the ERAS pathway at our center resulted in significantly reduced LOS and total hospital charge, with comparable rates of complication and readmission, highlighting the need for ERAS pathways in patients undergoing RC.
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Affiliation(s)
- Alice Semerjian
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Niv Milbar
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Max Kates
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael A Gorin
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hiten D Patel
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Heather J Chalfin
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Steven M Frank
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christopher L Wu
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William W Yang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Deb Hobson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lindsay Robertson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Mark P Schoenberg
- Montefiore Medical Center and Albert Einstein College of Medicine, Department of Urology, Bronx, NY
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael H Johnson
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C J Stimson
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
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Abstract
BACKGROUND Alvimopan is used in abdominal surgery to reduce postoperative ileus in patients undergoing small bowel resections with primary anastomosis. The role and efficacy of alvimopan in patients undergoing radical cystectomy with urinary diversion is not well understood. OBJECTIVES To assess the effects of alvimopan in the context of enhanced recovery pathways compared to enhanced recovery pathways alone for perioperative bowel dysfunction in patients undergoing radical cystectomy. SEARCH METHODS The terms alvimopan and cystectomy were used to search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase. We also reviewed abstracts from the past four years (2013 to 2016) of the American Urologic Association, Society of Urologic Oncology, and American Society of Clinical Oncology Genitourinary Cancers. SELECTION CRITERIA We searched for randomized controlled trials that compared alvimopan to placebo. DATA COLLECTION AND ANALYSIS This study was based on a published protocol. We performed a comprehensive search of multiple databases including CENTRAL in the Cochrane Library, MEDLINE, Embase, LILACS, Web of Science, Scopus and Biosis, which we last updated on 6 February 2017. We also searched abstract proceedings for major relevant meetings (2013 to 2016), databases of the grey literature, trial registries, citations of relevant reviews and contacted clinical experts and the drug manufacturer.Two independent reviewers screened the literature in two stages (title and abstract, full-text) using Covidence software. Two independent reviewers assessed the risk of bias on a 'per outcome' basis using the Cochrane 'Risk of bias; tool and rated the quality of evidence according to GRADE. Results of the single eligible trial were reported in a 'Summary of findings' table based on an intention-to-treat analysis. MAIN RESULTS Based on a single trial and moderate-quality evidence, alvimopan reduced the time to reach a composite endpoint of tolerance of solid food and documented bowel movements (hazard ratio (HR) 1.77, 95% confidence interval (CI) 1.41 to 2.23). This represents 165 more patients (109 more to 207 more) per 1000 meeting this endpoint within 10 days of surgery. Based on moderate-quality evidence, alvimopan reduced the time to hospital discharge (HR 1.67, 95% CI 1.38 to 2.01). This represents 138 more patients (82 more to 198 more) per 1000 being discharged within 10 days of surgery. Also based on moderate-quality evidence, alvimopan was associated with a reduced risk of major adverse events (risk ratio (RR) 0.28, 95% CI 0.18 to 0.44) representing 355 fewer patients (404 fewer to 276 fewer) with major adverse events per 1000. We downgraded this outcome for indirectness as it included adverse events that we did not consider major.In terms of secondary outcomes, alvimopan did not appear to alter the rate of readmission (RR 0.89, 95% CI 0.59 to 1.33), change the rate of any cardiovascular event (RR 0.54, 95% CI 0.27 to 1.05) or alter the mean narcotic pain medication use (mean difference 0, 95% CI 14.08 fewer to 14.08 more morphine equivalents). The quality of evidence was moderate for all three outcomes. Based on high-quality evidence, alvimopan reduced the rate of nasogastric tube replacement (RR 0.31, 95% CI 0.16 to 0.59). We did not find evidence for the drug's impact on rates of parenteral nutrition. All outcomes were short term and limited to a 30-day time horizon.Based on the existence of only one trial, we were unable to perform any subgroup or sensitivity analyses. AUTHORS' CONCLUSIONS In patients undergoing radical cystectomy and urinary diversion, the use of alvimopan administered as part of an enhanced recovery pathway for a limited duration (up to 15 doses for up to seven days) probably reduces the time to tolerance of solid food, time to hospital discharge and rates of major adverse events. Readmission rates, rates of cardiovascular events and narcotic pain requirements are probably similar. The need for reinsertion of nasogastric tubes is reduced. We found no evidence for the impact on rates of parenteral nutrition within 30 postoperative days.
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Affiliation(s)
- Shahnaz Sultan
- Minneapolis VA Health Care SystemGastroenterology Section III‐DOne Veterans DriveMinneapolisMinnesotaUSA55417
- University of MinnesotaDepartment of Medicine, Division of Gastroenterology, Hepatology and Nutrition420 Delaware Street SEMMC 36MinneapolisMinnesotaUSA55455
| | - Bernadette Coles
- Cardiff University Library ServicesVelindre NHS TrustVelindre Cancer CentreWhitchurchCardiffUKCF14 2TL
| | - Philipp Dahm
- Minneapolis VA Health Care SystemUrology SectionOne Veterans DriveMail Code 112DMinneapolisMinnesotaUSA55417
- University of MinnesotaDepartment of Urology420 Delaware Street SEMMC 394MinneapolisMinnesotaUSA55455
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Bazargani ST, Djaladat H, Ahmadi H, Miranda G, Cai J, Schuckman AK, Daneshmand S. Gastrointestinal Complications Following Radical Cystectomy Using Enhanced Recovery Protocol. Eur Urol Focus 2017; 4:889-894. [PMID: 28753885 DOI: 10.1016/j.euf.2017.04.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 03/23/2017] [Accepted: 04/03/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND The development of enhanced recovery after surgery (ERAS) protocols for patients undergoing radical cystectomy (RC) represents a significant advance in perioperative care. OBJECTIVE To evaluate gastrointestinal (GI) complications following RC and urinary diversion (UD) using our institutional ERAS protocol. DESIGN, SETTING, AND PARTICIPANTS We identified 377 consecutive cases of open RC and UD for which our ERAS protocol was used from May 2012 to December 2015. Exclusion criteria were consent refusal; non-bladder primary disease; palliative, salvage, or additional surgery; and prolonged postoperative intubation. A matched cohort of 144 patients for whom a traditional postoperative protocol (pre-ERAS) was used between 2003 and 2012 was selected for comparison. RESULTS AND LIMITATIONS A total of 292 ERAS patients with median age of 70 yr were included in the study, 65% of whom received an orthotopic neobladder. The median time to first flatus and bowel movement was 2 d. The median length of stay was 4 d. GI complications occurred in 45 patients (15.4%) during the first 30 d following RC, 93% of which were of minor grade. The most common GI complication was postoperative ileus (POI) in 34 cases (11.6%). Some 22 patients (7.5%) required a nasogastric tube, and parenteral nutrition was required in three patients. The rate of 30-d GI complications was significantly lower in the ERAS cohort than in the control group (13% vs 27%; p=0.003), as was the rate of POI (7% vs 23%; p<0.001). This effect was independent of other variables (hazard ratio 0.38, 95% confidence interval 0.18-0.82; p=0.01). CONCLUSIONS Our institutional ERAS protocol for RC is associated with significantly improved perioperative GI recovery and lower rates of GI complications. This protocol can be tested in multi-institutional studies to reduce GI morbidity associated with RC. PATIENT SUMMARY In this study, we showed that an enhanced recovery protocol for patients undergoing radical cystectomy for bladder cancer was associated with a significantly shorter length of hospital stay and lower rates of gastrointestinal complications, especially postoperative ileus.
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Affiliation(s)
- Soroush T Bazargani
- USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Hooman Djaladat
- USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Hamed Ahmadi
- Urology Department, Oregon Health & Science University, Portland, OR, USA
| | - Gus Miranda
- USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jie Cai
- USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Anne K Schuckman
- USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Siamak Daneshmand
- USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
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