ROBOTIC RADICAL CYSTECTOMY OUTCOMES BEFORE AND AFTER ENHANCED RECOVERY AFTER SURGERY (ERAS) PATHWAY
INTRODUCTION AND OBJECTIVES: Radical cystectomy (RC) represents a significant surgical challenge to patients. The ERAS pathway was designed to reduce surgical stress and complications in colorectal patients and has been subsequently adapted for urological use. The aim of this study is to compare the outcomes of Robotic RC (RRC) in patients with and without an ERAS pathway in a high-volume tertiary referral center.
METHODS: A total of 272 patients (n=76 No ERAS pathway, n=196 ERAS pathway) underwent a RRC with intention to cure from August 2009 to August 2016 as identified from our prospectively collated institutional approved database. Pre-, intra- and postoperative characteristics, oncological outcomes, 90-day complications, recurrence-free survival (RFS) and cost variables (adjusted to 2017 USD) were compared on univariate analysis. RFS was calculated by log-rank test and multivariable regression was used to assess the effect of ERAS on significant outcomes identified on univariate analysis.
RESULTS: Patients undergoing RRC without and with ERAS pathway were similar in terms of age (71 v 72yrs), sex, charlson-cormorbidity index, ASA, pathological outcomes, 90-day complication rates (79%v70%), readmission rates, RFS or total variable cost ($29,909 v $29,484 USD) (p>0.05). (Table 1) The use of intracorporeal diversion was more common during an ERAS pathway (p<0.001).
RRC with ERAS protocol was associated with a reduced LOS (7v5day p<0.001), reduced EBL and need for transfusion post-operatively (p<0.05). On multivariable analysis, after controlling for age, diversion type and Charlson score and p-stage, ERAS remained an independent predictive factor for reduced LOS and need for postoperative transfusion.
CONCLUSIONS: The use of ERAS pathway in RRC is associated with a reduced LOS and need for post-operative transfusion. ERAS pathway does not influence complication rates, readmission rates or total variable cost during RRC.
Radical cystectomy; ERAS; uro-oncology.
University of Southern California - - Estados Unidos
Pedro Glusman Knijnik, Pietro Waltrick Brum, Matthew Winter, Pierre A Hueber, Akbar Ashrafi, Mihir M Desai, Andre Abreu, Monish Aron, Inderbir Gill, Andre K Berger