Enhanced recovery after surgery in patients undergoing laparoscopic partial nephrectomy. Results from a real-world randomized controlled trial.

Xue, Xiaoqiang; Wang, Dong; Ji, Zhigang; Xie, Yi

doi:10.5114/wiitm.2021.108216

Cited by 3 publications

(3 citation statements)

References 22 publications

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“…Отмечен достоверно менее выраженный послеоперационный болевой синдром и риски развития послеоперационной тошноты и рвоты без увеличения риска реадмисии. Аналогичные выводы получены в исследованиях, посвященных сравнению стандартного лечебного подхода и протокола ускоренного выздоровления при резекции почки [9] и при донорской нефрэктомии [17]. При этом размер удаляемого органа не коррелирует напрямую с общим суммарным размером доступа и объемом операционной травмы при применении современного инструментария, шейвера или фрагментации удаляемой почки [18].…”

Section: Discussionunclassified

“…Особенно следует отметить, что по данным иссле-дования продленная госпитализация не влияет на частоту осложнений и риск реадмиссии [8]. Применение ПУВ при выполнении резекции почки сопровождается лучшим послеоперационным статусом пациентов, менее выраженной болью, меньшим сроком госпитализации, риском развития осложнений со стороны желудочно-кишечного тракта [9,10].…”

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Enchanced recovery after simple laparoscopic nephrectomy.

Vorobev¹,

Белобородов²,

Khovalyg³

et al. 2022

ECU

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Introduction. Simple nephrectomy is used for non-cancer diseases. That is, when the preservation of the kidney is unreasonable or dangerous. Since simple nephrectomy is a typical organ-delivering surgery, it is possible to optimize the perioperative period to reduce hospitalization and disability. The aim of the study was to compare the outcomes of simple laparoscopic nephrectomy using the enchanted recovery protocol and the standard approach. Materials and methods. A prospective randomized multicenter study included 27 patients with an established diagnosis of a non-functioning kidney, who were treated in the period 2018–2021 in urological hospitals in the city of Irkutsk. All patients were divided into two comparison groups: STANDART group (group I, n=14) and ENCHANCED RECOVERY group (group II, n=13). Results. Primary efficacy was comparable (p=0.892). It was found that the level of complications of class III according to Clavien-Dindo was statistically comparable in both groups (p>0.05), and the level of complications of class II was significantly higher in group I (p<0.05). When comparing the duration of hospitalization, there is a significantly (p <0.001) longer stay of patients in group I (9.5±2.2 days) compared to group II (1.0±0.0 days). Subjective satisfaction with the treatment performed (upon requesting a critical analysis of all possible complaints) was comparable and amounted to 57.1% for group I and 100% for group II (p=0.342). When conducting a logistic regression analysis for postoperative febrile condition, according to multivariate regression, the volume of intraoperative infusion was found to be a significant predictor (for each +1 ml; OR 0.003; 95% CI 0.0001; 0.005; p = 0.042); for postoperative pain syndrome >5 VAS points – increase in the size of the surgical approach per 1 mm (OR 0.14; 95% CI -0.01; 0.307; p = 0.077); for satisfaction with treatment, a negative effect of the duration of the postoperative stay was found (for each +1 day; OR -1.08; 95% CI -2.32; 0.15; p = 0.086). Conclusion. Simple laparoscopic nephrectomy under the enchanted recovery protocol allows achieving similar treatment results without increasing the risk of readmission or reoperation, but with the achievement of a better subjective and objective postoperative status of the patient.

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Section: Discussionunclassified

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Enchanced recovery after simple laparoscopic nephrectomy.

Vorobev¹,

Белобородов²,

Khovalyg³

et al. 2022

ECU

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“…In clinical work, some doctors may have inertial thinking similar to asymptomatic UTUC and asymptomatic bladder cancer, and they are more inclined to perform kidney-retaining surgery. On the other hand, fast-track surgery and enhanced recovery after surgery has been widely adopted in the field of general surgery [ 15 ]. However, we found that the stage and grade of UTUC were not related to the presence of symptoms.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic strategies for asymptomatic upper urinary tract urothelial carcinoma.

Lin¹,

Yang²,

Yang³

et al. 2022

Videosurgery and Other Miniinvasive Techniques

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Introduction: Upper urinary tract epithelial carcinoma (UTUC) and bladder cancer are both sources of urinary epithelial cell. In our previous study of asymptomatic bladder tumors, we found that most of these tumors could be resected through the urethra without radical surgery. This study analyzed the treatment strategies for asymptomatic UTUC. Aim: To investigate the clinicopathological features and surgical methods of these patients, thus choosing appropriate surgical treatment. Material and methods: 136 patients with UTUC were recruited, of whom 21 patients with asymptomatic UTUC were group A, and 115 UTUC patients with hematuria or low back pain were group B. The clinicopathological features, oncologic outcomes, and surgical methods of patients were evaluated. Results: Radical resection was the main surgical treatment which was included (group A 80.95%, group B 90.43%). Other patients were treated with kidney-retaining surgery. No statistically significant difference was observed in the pathological stage and grade between groups A and B (p > 0.05). During a median follow-up period of 44.3 months, tumor-specific mortality of group A was 7.14%, and that of group B was 5.10%. In the same period, 106 patients with asymptomatic bladder tumor were recruited: 31 patients of them had asymptomatic bladder urothelial carcinoma. The asymptomatic UTUC group had a higher stage and grade of clinicopathological features than the asymptomatic bladder urothelial carcinoma group (p < 0.001). Conclusions: The principle of asymptomatic UTUC treatment is the same as that of symptomatic UTUC. Risk stratification should be carried out according to clinical staging and other parameters, and the corresponding surgical treatment should be selected.

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Application of enhanced recovery after surgery in partial nephrectomy for renal tumors: A systematic review and meta-analysis

Tianyi²,

Ma³

et al. 2023

Front. Oncol.

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ObjectivesIn recent years, enhanced recovery after surgery (ERAS) has been widely used in the field of urology, especially in radical cystectomy and radical prostatectomy, and has demonstrated its advantages. Although studies on the application of ERAS in partial nephrectomy for renal tumors are increasing, the conclusions are mixed, especially in terms of postoperative complications, etc, and its safety and efficacy are questionable. We conducted a systematic review and meta-analysis to assess the safety and efficacy of ERAS in the application of partial nephrectomy for renal tumors.MethodsPubmed, Embase, Cohrance library, Web of science and Chinese databases (CNKI, VIP, Wangfang and CBM) were systematically searched for all published literature related to the application of enhanced recovery after surgery in partial nephrectomy for renal tumors from the date of establishment to July 15, 2022, and the literature was screened by inclusion/exclusion criteria. The quality of the literature was evaluated for each of the included literature. This Meta-analysis was registered on PROSPERO (CRD42022351038) and data were processed using Review Manager 5.4 and Stata 16.0SE. The results were presented and analyzed by weighted mean difference (WMD), Standard Mean Difference (SMD) and risk ratio (RR) at their 95% confidence interval (CI). Finally, the limitations of this study are analyzed in order to provide a more objective view of the results of this study.ResultsThis meta-analysis included 35 literature, including 19 retrospective cohort studies and 16 randomized controlled studies with a total of 3171 patients. The ERAS group was found to exhibit advantages in the following outcome indicators: postoperative hospital stay (WMD=-2.88, 95% CI: -3.71 to -2.05, p<0.001), total hospital stay (WMD=-3.35, 95% CI: -3.73 to -2.97, p<0.001), time to first postoperative bed activity (SMD=-3.80, 95% CI: -4.61 to -2.98, p < 0.001), time to first postoperative anal exhaust (SMD=-1.55, 95% CI: -1.92 to -1.18, p < 0.001), time to first postoperative bowel movement (SMD=-1.52, 95% CI: -2.08 to -0.96, p < 0.001), time to first postoperative food intake (SMD=-3.65, 95% CI: -4.59 to -2.71, p<0.001), time to catheter removal (SMD=-3.69, 95% CI: -4.61 to -2.77, p<0.001), time to drainage tube removal (SMD=-2.77, 95% CI: -3.41 to -2.13, p<0.001), total postoperative complication incidence (RR=0.41, 95% CI: 0.35 to 0.49, p<0.001), postoperative hemorrhage incidence (RR=0.41, 95% CI: 0.26 to 0.66, p<0.001), postoperative urinary leakage incidence (RR=0.27, 95% CI: 0.11 to 0.65, p=0.004), deep vein thrombosis incidence (RR=0.14, 95% CI: 0.06 to 0.36, p<0.001), and hospitalization costs (WMD=-0.82, 95% CI: -1.20 to -0.43, p<0.001).ConclusionERAS is safe and effective in partial nephrectomy of renal tumors. In addition, ERAS can improve the turnover rate of hospital beds, reduce medical costs and improve the utilization rate of medical resources.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO, identifier CRD42022351038.

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Enhanced recovery after surgery in patients undergoing laparoscopic partial nephrectomy. Results from a real-world randomized controlled trial.

Cited by 3 publications

References 22 publications

Enchanced recovery after simple laparoscopic nephrectomy.

Enchanced recovery after simple laparoscopic nephrectomy.

Therapeutic strategies for asymptomatic upper urinary tract urothelial carcinoma.

Application of enhanced recovery after surgery in partial nephrectomy for renal tumors: A systematic review and meta-analysis

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