Enhanced recovery after surgery for radical cystectomy with ileal urinary diversion: a multi-institutional, randomized, controlled trial from the Chinese bladder cancer consortium

Enhanced recovery after surgery (ERAS) has played an important role in recovery management for radical cystectomy with ileal urinary diversion (RC-IUD). This study is to evaluate ERAS compared with the conventional recovery after surgery (CRAS) for RC-IUD.

From October 2014 and July 2016, bladder cancer patients scheduled for curative treatment from 25 centers of Chinese Bladder Cancer Consortium were randomly assigned to either ERAS or CRAS group. Primary endpoint was the 30-day complication rate. Secondary endpoints included recovery of fluid and regular diet, flatus, bowel movement, ambulation, and length of stay (LOS) postoperatively. Follow-up period was 30-day postoperatively.

There were 144 ERAS and 145 CRAS patients. Postoperative complications occurred in 25.7 and 30.3% of the ERAS and CRAS patients with 55 complications in each group, respectively (p = 0.40). There was no significant difference between groups in major complications (p = 0.82), or type of complications (p = 0.99). The ERAS group had faster recovery of bowel movements (median 88 versus 100 h, p = 0.01), fluid diet tolerance (68 versus 96 h, p < 0.001), regular diet tolerance (125 versus 168 h, p = 0.004), and ambulation (64 versus 72 h, p = 0.047) than the CRAS group, but similar time to flatus and LOS.

ERAS did not increase 30-day complications compared with CRAS after RC. ERAS may be better than CRAS in terms of bowel movement, tolerance of fluid and regular diet, and ambulation.

World journal of urology. 2017 Oct 28 [Epub ahead of print]

Tianxin Lin, Kaiwen Li, Hao Liu, Xueyi Xue, Ning Xu, Yong Wei, Zhiwen Chen, Xiaozhou Zhou, Lin Qi, Wei He, Shiyu Tong, Fengshuo Jin, Xudong Liu, Qiang Wei, Ping Han, Xin Gou, Weiyang He, Xu Zhang, Guoqiang Yang, Zhoujun Shen, Tianyuan Xu, Xin Xie, Wei Xue, Ming Cao, Jin Yang, Jianyun Hu, Fubao Chen, Peijun Li, Guangyong Li, Tong Xu, Ye Tian, Wenying Wang, Dongkui Song, Lei Shi, Xiaoming Yang, Yang Yang, Benkang Shi, Yaofeng Zhu, Xigao Liu, Jinchun Xing, Zhun Wu, Kaiyan Zhang, Wei Li, Chaozhao Liang, Cheng Yang, Wei Li, Jinchun Qi, Chuanliang Xu, Weidong Xu, Liqun Zhou, Lin Cai, En'ci Xu, Weizhong Cai, Minggao Weng, Yiming Su, Fangjian Zhou, Lijuan Jiang, Zhuowei Liu, Qiuhong Chen, Tiejun Pan, Bo Liu, Yu Zhou, Xin Gao, Jianguang Qiu, Jie Situ, Cheng Hu, Shan Chen, Yupeng Zheng, Jian Huang

Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 W Yanjiang Road, Yuexiu District, Guangzhou, 510120, Guangdong, China., Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China., Department of Urology, Southwest Hospital, Third Military Medical University, Chongqing, China., Department of Urology, Xiangya Hospital of Central South University, Changsha, Hunan, China., Department of Urology, The Third Affiliated Hospital, Third Military Medical University, Chongqing, China., Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China., Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China., Department of Urology, Chinese PLA General Hospital, Beijing, China., Department of Urology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China., Department of Urology, Renji Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China., Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China., Department of Urology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China., Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China., Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China., Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, China., Department of Urology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China., Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China., Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China., Department of Urology, Shanghai Changhai Hospital of Second Military Medical University, Shanghai, China., Department of Urology, Peking University First Hospital, Beijing, China., Department of Urology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China., Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China., Department of Urology, Wuhan General Hospital of Guangzhou Military Command, Wuhan, Hubei, China., Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China., Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China., Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 W Yanjiang Road, Yuexiu District, Guangzhou, 510120, Guangdong, China. .