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Bladder cancer is the ninth most common cancer worldwide, with an estimated 430 000 new cases in 2012. In Egypt, bladder cancer has been the most common cancer during the past 50 years. Radical cystectomy is the standard treatment for patients with invasive bladder cancer and for those with superficial bladder cancer who did not respond to intra vesical therapy. In the past decade, mortality has been reduced to 0–3.9%, while early morbidity remains at 11–68%. Successful application of an enhanced recovery protocol aims at improving postoperative recovery via early mobilization and quick return to oral diet which may lead to a shorter Length Of Stay in hospital.
We aim from this thesis to examine the current evidence for ERAS in preoperative, intraoperative and post-operative setting of care for Radical Cystectomy patients, to propose ERAS evidence-based protocol for patients undergoing Radical Cystectomy in Egypt environment and to compare the effectiveness of ERAS versus standard care on perioperative outcomes after cystectomy including Length of Hospital Stay, bowel movement, Complications and Readmission Rate in 30 days.
This is a prospective randomized comparative study done at the urology departments of Ain Shams University and Nasser institute for research and treatment in 2018.
Forty patients were included in this study who were indicated For Radical Cystectomy. They were recruited and randomized in two groups: group A: where they followed enhanced recovery after Surgery protocols and group B: where they followed the the classic pre-operative and post-operative protocols.
The main differences between both protocols consisted of the absence of preoperative counseling, preoperative bowel preparation, long period antibiotics preoperative, preoperative carbohydrate loading, Prophylacic anticoagulant until discharge, fasting from midnight, absence of controlled perioperative fluid management, absence of enough preventive measures towards postoperative Ileus management (chewing gum, …), and absence of early mobilization and early oral diet in the standard of care group.
We finished to that Enhanced recovery after surgery (ERAS) protocols in radical cystectomy is safe and not associated with any increase in intraoperative and post-operative complications compared to standard protocol. It is associated with reductions in the length of hospital stay, time to return to full diet, time to flatulence, time for defecation and pain post-operative. There is no difference in 30 day readmission rate between ERAS and Standard Care.
Our prospective randomized controlled trial covers most of the items recommended for ERAS excluding the use of a laparoscopic or robotic approach, Audit, and use of alvimopan, a peripherally acting μ-opioid antagonist, which is not available in Egypt.
Our study reveals many issues that need to be considered when designing a larger more powered study.