The robotic approach improves the outcomes of ERAS protocol after radical cystectomy: A prospective case-control analysis

Schiavina, Riccardo; Droghetti, Matteo; Bianchi, Lorenzo; Ercolino, Amelio; Chessa, F.; Casablanca, Carlo; Piazza, Pietro; Mottaran, Angelo; Recenti, Dario; Salvador, M.; Cacciapuoti, Crescenzo; Boschi, Sara; Giampaoli, Marco; Bertaccini, Alessandro; Romagnoli, Daniele; Porreca, Angelo

doi:10.1016/j.urolonc.2021.04.015

Cited by 14 publications

(14 citation statements)

References 20 publications

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“…Concerning the potential advantages of ERAS, Feng et al suggested that ERAS can promote early GI function recovery, thus, facilitating wound healing, which might help avoid severe morbidity [21]. In contrast, we found that eRARC was not associated with improvement in major complications-resembling the ndings of several prospective studies of iRARC after ERAS [12,13].…”

Section: Discussionsupporting

confidence: 69%

“…Moreover, eRARC was not a signi cant predictor of shortened LOS in multivariate analysis. Chen et al and Schiavina et al demonstrated additive e cacy for RARC after ERAS, but their analyses were limited to patients undergoing iRARC [12,13]. The evidence for the superiority of iRARC compared with eRARC has emerged mainly from high-volume academic centers [18,19].…”

Section: Discussionmentioning

confidence: 99%

“…A previous study that analyzed both considered only RARC with intracorporeal urinary diversion (iRARC) [10]. Other studies evaluated the bene ts of iRARC after ERAS, but none evaluated RARC with extracorporeal urinary diversion (eRARC) in a similar setting [11][12][13]. The learning curve for the complicated surgical skills of urinary reconstruction in iRARC suggests that the surgeon and hospital volume might be associated with complication rates [2,14].…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of the Addition of Robot-assisted Radical Cystectomy with Extracorporeal Urinary Diversion after an Enhanced Recovery Protocol

Yamamoto

Naito

et al. 2023

Preprint

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Background: Evaluation of the benefits to postoperative outcomes of introducing robot-assisted radical cystectomy (RARC) to enhanced recovery after surgery (ERAS) is limited, especially in RARC with extracorporeal urinary diversion (eRARC). We assessed whether eRARC, when added to ERAS, provided additional efficacy in terms of patient outcomes during its initial implementation. Methods: We retrospectively identified 143 patients undergoing radical cystectomy with urinary diversion between June 2010 and December 2021 at a single center. The patients were assigned to three groups based on the type of surgical procedures and perioperative recovery protocols used. Length of hospital stay (LOS) and 90-day postoperative complication rates were compared between the groups. Regression analyses were performed to evaluate how ERAS and eRARC affected outcomes. Whereas, multivariate analysis was used to detect LOS predictors. Results: The median LOS was shorter with ERAS and eRARC (28.0 vs. 20.0 vs. 17.0 days, P < 0.001). In the linear regression model, ERAS was associated with a significantly shorter LOS (10.4 days, P < 0.001); eRARC was also associated with a shorter LOS, but the difference was nonsignificant (4.10 days, P = 0.14). Neither ERAS nor eRARC was associated with a significant improvement in complications. Following multivariate analysis, ERAS was found to be independently associated with shorter LOS (OR 0.23, P < 0.001), but eRARC showed no such association (OR 0.29, P = 0.096). Conclusion: ERAS was significantly associated with shorter LOS. Although a desirable trend was evident, eRARC did not contribute to additional efficacy. Neither ERAS nor eRARC improved complications.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy of the Addition of Robot-assisted Radical Cystectomy with Extracorporeal Urinary Diversion after an Enhanced Recovery Protocol

Yamamoto

Naito

et al. 2023

Preprint

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“…Initially applied to colorectal surgery, ERAS protocols have gradually been adopted by other types of surgery as well, including urology [ 26 , 27 ]. Recommended by the EAU [ 1 ] and AUA [ 28 ] guidelines for RC with UD, ERAS protocols still do not represent the standard of care [ 29 , 30 ]. There are still few findings in the literature regarding patients who have undergone RC, but the available studies have yielded positive results [ 19 , 31 , 32 , 33 , 34 , 35 ].…”

Section: Orthotopic Neobladdermentioning

confidence: 99%

Neobladder “Function”: Tips and Tricks for Surgery and Postoperative Management

Fasanella

Marchioni

Domanico

et al. 2022

Life

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Orthotopic neobladder (ONB) reconstruction is a continent urinary diversion procedure increasingly used in patients with muscle-invasive bladder cancer following radical cystectomy (RC). It represents a valid alternative to the ileal duct in suitable patients who do not prefer a stoma and are motivated to undergo adequate training of the neobladder. Careful patient selection, taking into account the absolute and relative contraindications for ONB as well as an adequate recovery protocol after surgery are integral to the success of this procedure and the oncological and functional outcomes. The objective of this review is to summarize the current data on RC with ONB in terms of patient selection, preoperative preparation, surgical techniques and functional (continence and sexual activity) and oncological outcomes, with particular attention to the management of complications and the impact on quality of life (QoL).

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“…ER, after‐surgery utilisation, may lead to a shorter length of stay, fewer problems, lower expenditures, and better wound healing 5‐13 . However, fewer reports compare ER after surgery's effect on wound dehiscence 14‐18 . We sought to comprehensively analyse in this meta‐analysis the outcome of ER after RC on wound dehiscence.…”

Section: Introductionmentioning

confidence: 99%

Wound dehiscence in enhanced recovery after open radical cystectomy: A meta‐analysis

Xue

Liu

et al. 2023

International Wound Journal

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A meta‐analysis study to assess the outcome of enhanced recovery (ER) after radical cystectomy (RC) on wound dehiscence was performed. A comprehensive literature examination till January 2023 was implemented and 1457 linked studies were appraised. The picked studies contained 772 open RC subjects in the picked studies' baseline, 436 of them were enhanced recovery after RC, and 336 were open RC. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to calculate the consequence of enhanced recovery after RC on wound dehiscence after open RC by the dichotomous styles and a fixed or random model. The ER after RC caused significantly lower wound dehiscence (OR, 0.51; 95% CI, 0.30–0.89, P = .02) with low heterogeneity (I2 = 46%) compared with open RC. The ER after RC caused significantly lower wound dehiscence compared with open RC. Thorough precaution should be taken when commerce with the consequences because a limited number of studies were found and selected for this meta‐analysis.

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The robotic approach improves the outcomes of ERAS protocol after radical cystectomy: A prospective case-control analysis

Cited by 14 publications

References 20 publications

Efficacy of the Addition of Robot-assisted Radical Cystectomy with Extracorporeal Urinary Diversion after an Enhanced Recovery Protocol

Efficacy of the Addition of Robot-assisted Radical Cystectomy with Extracorporeal Urinary Diversion after an Enhanced Recovery Protocol

Neobladder “Function”: Tips and Tricks for Surgery and Postoperative Management

Wound dehiscence in enhanced recovery after open radical cystectomy: A meta‐analysis

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