Current Strategies to Enhance Recovery following Radical Cystectomy: Single Centre Initial Experience

Abstract

A radical cystectomy (RC) with pelvic lymph node dissection is the gold standard treatment for muscle-invasive bladder carcinoma. The morbidity associated with RC is clearly lower than that in the previous decades; it still continues to remain higher than 30% in the early postoperative period associated with and remains the most effective method for local control. We present current strategies being developed to further enhance recovery in patients undergoing RC and stratifying these into pre, intra, and post operative. We present our current strategies to enhance revcovery in patients undergoing RC which includes a combination of a through preoperative assessment with cardiopulmonary exercise (CPX), preoperative carbohydrate loading drinks, and intraoperative fluid monitoring with the trans-oesophageal Doppler probe (TODP) that may enhance recovery following radical cystectomy. We conclude that using these strategies may not only help in reducing peri/post operative morbidity and the duration of inpatient stay but may also help in enhancing the patient's long-term recovery.

Clinical and patient‐reported outcomes of SPARE – a randomised feasibility study of selective bladder preservation versus radical cystectomy

“…The technical delivery of RT has also improved with the advent of adaptive and image‐guided techniques , so one may expect improved outcomes with RT in the future. Likewise developments in surgery with increasing use of bladder reconstruction, enhanced recovery pathways , and minimally invasive techniques , should result in benefits for patients.…”

Cardiopulmonary exercise testing in patients undergoing radical cystectomy (open, laparoscopic and robotic)

“…Patients deemed to have low cardiorespiratory fitness are then able to receive interventions to attempt to reduce length of hospital stay and improve survival postoperatively. 1 One intervention with potential is preoperative exercise training, which has been shown to improve cardiorespiratory fitness both in healthy and unhealthy patients. 9 The ability to improve fitness levels preoperatively, and therefore potentially improve anaerobic thresholds, could have major implications on postoperative outcomes.…”

“…Radical cystectomy (RC) with pelvic lymph node dissection is the gold-standard treatment in the appropriately selected patient for muscle-invasive bladder carcinoma. 1 Annually, around 1200 RCs are performed in the United Kingdom (UK), of which over 60% are on patients over the age of 65 years. 2 RC constitutes major uro-oncological surgery and has the potential for serious complications, with a morbidity rate of over 30% despite advances in surgical techniques.…”

“…2 RC constitutes major uro-oncological surgery and has the potential for serious complications, with a morbidity rate of over 30% despite advances in surgical techniques. 1 With operative durations of between three and eight hours, the procedure is highly demanding on patient physiology, producing a significant proinflammatory response and demanding high oxygen supply and tissue perfusion. 1 Overall mortality stands at 5.6% in the UK, but the majority of this is a result of exacerbation of co-morbid conditions rather than postoperative complications.…”

“…1 With operative durations of between three and eight hours, the procedure is highly demanding on patient physiology, producing a significant proinflammatory response and demanding high oxygen supply and tissue perfusion. 1 Overall mortality stands at 5.6% in the UK, but the majority of this is a result of exacerbation of co-morbid conditions rather than postoperative complications. 2 Thus the preoperative period is a major target in order to reduce the high levels of morbidity and mortality associated with RC.…”