Does Postoperative Rehabilitation for Radical Cystectomy Call for Enhanced Recovery after Surgery? A Systematic Review and Meta-analysis

Xiao, Jun; Wang, Meng; He, Wei; Wang, Jing; Yang, Fan; Ma, Xueyou; Zang, Yu; Yang, Chunguang; Yu, Guangrong; Wang, Zhihua; Ye, Zhangqun

doi:10.1007/s11596-019-2006-6

Cited by 20 publications

(18 citation statements)

References 47 publications

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“…Above mentioned findings are partly concordant to other meta-analyses published on this topic [12,41]. We were able to support their findings on LOS and in the pooling of all patients for complications and time to defecation with an even larger selection of studies in comparison to the mentioned reviews.…”

Section: Discussionsupporting

confidence: 91%

Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

et al. 2020

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Purpose Different enhanced recovery after surgery (ERAS) protocols (EP) for radical cystectomy (RC) have been published. Protocols highly differ in number of included items and specific measures. Materials and methods A systematic review and meta-analysis on EPs in RC were performed using the databases MedLine, Cochrane Library, Web of science, and Google Scholar. The specific ERAS measures of the protocols were extracted, analyzed, and compared. Pooling of available outcome data was performed for length of stay, complications, readmission rate, and time to defecation. Results The search yielded a total of 860 studies of which 25 studies were included in qualitative and 22 in quantitative analysis. Oral bowel preparation (BP) was omitted in 24/25 (96%) EPs, optimized fluid management was administered in 22/25 (88%) EPs and early mobilization (postoperative day 1) in 21/25 (84%). Gum chewing (n = 12, 46%), metoclopramide (n = 11, 44%), and alvimopan (n = 6, 24%) were the most common measures to prevent postoperative ileus. Our meta-analysis revealed a significant benefit in favor of EPs for the outcome parameters length of stay [mean difference (MD) − 3.46 d, 95% confidence interval (CI) − 4.94 to − 1.98, p < 0.01], complications [Odds ratio (OR) = 0.76, 95% CI 0.61-0.94, p = 0.01] and time to defecation (MD − 1.37 d, 95% CI − 2.06 to − 0.69, p < 0.01). Readmission rate did not show a significant difference (OR = 0.73, 95% CI 0.52-1.03, p = 0.07). Conclusion Current EPs focus on omitting oral BP, early mobilization, and optimized fluid management while they differ in methods preventing postoperative ileus. Our meta-analysis revealed a benefit in introducing these protocols into clinical practice.

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Section: Discussionsupporting

confidence: 91%

Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

et al. 2020

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“…Compared with the previous studies (20,25,26), our metaanalysis has the following advantages. First, our study involved seven RCTs.…”

Section: Discussionmentioning

confidence: 99%

“…Tyson et al (20) showed that compared with the conventional protocol, the ERAS protocol had advantages in patients undergoing cystectomy and urinary diversion. Xiao et al (26) demonstrated that implementation of the ERAS protocol could decrease the incidence of postoperative complications after radical cystectomy. However, the ERAS protocols were not suitable for every patient because of the diverse individual characteristics.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of the Efficacy and Safety of Enhanced Recovery After Surgery vs. Conventional Recovery After Surgery on Perioperative Outcomes of Radical Cystectomy

et al. 2020

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Background and objective: Radical cystectomy has been characterized as the most difficult operation in urology because of the complex surgical procedures and postoperative complications. Enhanced recovery after surgery (ERAS), which reduces the incidence of perioperative complications, has been widely used in clinical surgery. Herein, we performed a meta-analysis to evaluate the efficacy and safety of ERAS vs. conventional recovery after surgery (CRAS) on perioperative outcomes of radical cystectomy. Methods: We performed a systematic search of randomized controlled trials (RCTs) in the following databases: Medline, Embase, and the Cochrane Controlled Trials Register, based on the PICOS strategy. The reference lists of the retrieved studies were further surveyed for relevant publications. Results: Our search yielded seven RCTs containing 813 patients. The ERAS group was found to have better performance in the following parameters: length of hospital stay [mean difference (MD) = −1.12, 95% confidence interval (CI): −1.80 to −0.45, P = 0.001], time to first flatus (MD = −0.70, 95% CI: −0.98 to 0.41, P < 0.00001), and time to regular diet (MD = −0.12, 95% CI: −1.76 to −0.28, P = 0.007). However, there were no significant differences between the two groups in major complications [odds ratio (OR) = 0.91, 95% CI: 0.63 to 1.34, P = 0.64], readmission (OR = 1.15, 95% CI: 0.65 to 2.01, P = 0.63), ileus (OR = 0.75, 95% CI: 0.44 to 1.28, P = 0.29), wound infection (OR = 0.56, 95% CI: 0.31 to 1.01, P = 0.05), mortality (OR = 0.69, 95% CI: 0.24 to 1.99, P = 0.49), or time to first bowel movement (MD = −0.55, 95% CI: −1.62 to 0.53, P = 0.32). Conclusion: ERAS reduced the length of hospital stay, time to first flatus, and time to regular diet after cystectomy. Compared to CRAS protocols, ERAS protocols do not increase the risk of adverse events.

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“…However, the differences of interpretative measures (including operative time and blood loss) and the occurrence of complications (including nausea, intestinal obstruction, urinary tract infection, urinary leakage, and deep venous thrombosis) remained no statistical significance. To date, numerous articles have been performed to explore the efficacy and safety of ERAS program in laparoscopic surgery of various diseases, such as colorectal cancer, gastric cancer, bladder cancer, and hepatocellular cancer [17][18][19][20][21]. Ni et al [17] reported 13 RCTs of ERAS program in laparoscopic colorectal cancer surgery.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of enhanced recovery after surgery (ERAS) program in patients undergoing radical prostatectomy: a systematic review and meta-analysis

et al. 2020

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Background: Enhanced recovery after surgery (ERAS) protocol has been identified to be beneficial in the amount of operations such as gastrointestinal surgery. However, the efficacy and safety in robot-assisted laparoscopic prostatectomy/laparoscopic radical prostatectomy (RALP/LRP) still remain controversial. Method: We searched randomized controlled trials and retrospective cohort studies comparing ERAS versus conventional care for prostate cancer patients who have undergone RALP/LRP. ERAS-related data were extracted, and quality of included studies was assessed using the Newcastle-Ottawa quality assessment scale and the Jadad scale. Result: As a result, seven trials containing 784 prostate cancer patients were included. ERAS was observed to be significantly associated with shorter length of hospital stay (SMD − 2.55, 95%CI − 3.32 to − 1.78, P < 0.05), shorter time to flatus (SMD − 1.55, 95%CI − 2.26 to − 0.84, P < 0.05), shorter time to ambulate (SMD − 6.50, 95%CI − 10.91 to − 2.09, P < 0.05), shorter time to defecate (SMD − 2.80, 95%CI − 4.56 to − 1.04, P < 0.05), and shorter time to remove drainage tube (SMD − 2.72, 95%CI − 5.31 to − 0.12, P < 0.05). Otherwise, no significant difference was reported in other measurements. Conclusions: In conclusion, ERAS can reduce length of hospital stay, time to flatus, time to defecate, time to ambulate, and time to remove drainage tube in prostate cancer patients who have undergone RALP/LRP compared with conventional care.

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Does Postoperative Rehabilitation for Radical Cystectomy Call for Enhanced Recovery after Surgery? A Systematic Review and Meta-analysis

Cited by 20 publications

References 47 publications

Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

Systematic Review and Meta-Analysis of the Efficacy and Safety of Enhanced Recovery After Surgery vs. Conventional Recovery After Surgery on Perioperative Outcomes of Radical Cystectomy

Clinical efficacy of enhanced recovery after surgery (ERAS) program in patients undergoing radical prostatectomy: a systematic review and meta-analysis

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