Perioperative results of radical cystectomy after neoadjuvant chemotherapy according to the implementation of ERAS pathway.

Cystectomy / methods Humans Neoadjuvant Therapy Postoperative Complications / etiology Retrospective Studies Urinary Bladder / pathology Urinary Bladder Neoplasms / drug therapy
Chimiothérapie néoadjuvante Complications Complications postopératoires Cystectomie radicale ERAS Neaoadjuvant chemotherapy RAAC Radical cystectomy

Journal

Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie
ISSN: 1166-7087
Titre abrégé: Prog Urol
Pays: France
ID NLM: 9307844

Informations de publication

Date de publication:
May 2022
Historique:
received: 09 07 2021
revised: 27 10 2021
accepted: 10 01 2022
pubmed: 17 2 2022
medline: 24 5 2022
entrez: 16 2 2022
Statut: ppublish

Résumé

The effect of ERAS protocols in a population of radical cystectomy (RC) patients fit for neoadjuvant chemotherapy has not been specifically explored. To compare perioperative outcomes of open RC according to the application of an ERAS protocol in a population of patients treated by cisplatin-based NAC. All consecutive patients treated by NAC and RC between 2016 and 2019 were included. The ERAS pathway was implemented in June 2018 and followed the EAU recommendations. All data were prospectively collected. Patients' characteristics, operative outcomes, length of stay (LOS), complication rate according to Clavien-Dindo and pathological results were compared between pre- and post-ERAS. Statistical analysis was performed using R. In total, 79 patients were included, 29 in the ERAS group and 50 in the non-ERAS group. A median number of 19 out of 22 ERAS criteria were followed. Mean number of NAC cycles was 4.45 vs. 4.79 in the pre- and post-ERAS groups respectively (P=0.24). Median time between NAC and RC was 3.8months. Thirty-eight percent vs. 48% of patients received an ileal neobladder in the pre- and post-ERAS group respectively (P=0.51). No differences were observed regarding operative time, blood loss or operative transfusion rates. LOS was drastically reduced in the ERAS period (18.94 vs. 12.10days, P<0.001) as well as major (>Clavien 2) complications rate (65% vs. 28%, P=0.004). ERAS drastically reduced the LOS and the rate of high-grade complications and can be effectively applied to patients receiving NAC without delaying RC.

Sections du résumé

BACKGROUND BACKGROUND
The effect of ERAS protocols in a population of radical cystectomy (RC) patients fit for neoadjuvant chemotherapy has not been specifically explored.
OBJECTIVE OBJECTIVE
To compare perioperative outcomes of open RC according to the application of an ERAS protocol in a population of patients treated by cisplatin-based NAC.
METHODS METHODS
All consecutive patients treated by NAC and RC between 2016 and 2019 were included. The ERAS pathway was implemented in June 2018 and followed the EAU recommendations. All data were prospectively collected. Patients' characteristics, operative outcomes, length of stay (LOS), complication rate according to Clavien-Dindo and pathological results were compared between pre- and post-ERAS. Statistical analysis was performed using R.
RESULTS RESULTS
In total, 79 patients were included, 29 in the ERAS group and 50 in the non-ERAS group. A median number of 19 out of 22 ERAS criteria were followed. Mean number of NAC cycles was 4.45 vs. 4.79 in the pre- and post-ERAS groups respectively (P=0.24). Median time between NAC and RC was 3.8months. Thirty-eight percent vs. 48% of patients received an ileal neobladder in the pre- and post-ERAS group respectively (P=0.51). No differences were observed regarding operative time, blood loss or operative transfusion rates. LOS was drastically reduced in the ERAS period (18.94 vs. 12.10days, P<0.001) as well as major (>Clavien 2) complications rate (65% vs. 28%, P=0.004).
CONCLUSION CONCLUSIONS
ERAS drastically reduced the LOS and the rate of high-grade complications and can be effectively applied to patients receiving NAC without delaying RC.

Identifiants

DOI: 10.1016/j.purol.2022.01.003 PMID: 35168897
pubmed: 35168897
pii: S1166-7087(22)00009-4
doi: 10.1016/j.purol.2022.01.003
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

401-409

Informations de copyright

Copyright © 2022 Elsevier Masson SAS. All rights reserved.

Auteurs

T-R Dobé (TR)

AP-HP, Urology Department, Hôpital Saint-Louis, Paris, France.

Y Belhadj (Y)

AP-HP, Urology Department, Hôpital Saint-Louis, Paris, France.

C Michel (C)

AP-HP, Urology Department, Hôpital Saint-Louis, Paris, France.

M Djouadou (M)

AP-HP, Urology Department, Hôpital Saint-Louis, Paris, France.

A Bouchardi (A)

AP-HP, Urology Department, Hôpital Saint-Louis, Paris, France.

C Liron (C)

AP-HP, Urology Department, Hôpital Saint-Louis, Paris, France.

C Bento (C)

AP-HP, Urology Department, Hôpital Saint-Louis, Paris, France.

A Aregui (A)

AP-HP, Ucog Paris-Nord, Hôpitaux Bichat, Bretonneau, Saint-Louis, Paris, France.

P Meria (P)

AP-HP, Urology Department, Hôpital Saint-Louis, Paris, France.

A Thevenot (A)

AP-HP, Anesthesiology Department, Hôpital Saint-Louis, Paris, France.

B Plaud (B)

AP-HP, Anesthesiology Department, Hôpital Saint-Louis, Paris, France.

S Culine (S)

Université de Paris, Paris, France; AP-HP, Oncology Department, Hôpital Saint-Louis, Paris, France.

P Mongiat-Artus (P)

AP-HP, Urology Department, Hôpital Saint-Louis, Paris, France; Université de Paris, Paris, France.

F Desgrandchamps (F)

AP-HP, Urology Department, Hôpital Saint-Louis, Paris, France; Université de Paris, Paris, France.

A Masson-Lecomte (A)

AP-HP, Urology Department, Hôpital Saint-Louis, Paris, France; Université de Paris, Paris, France. Electronic address: amassonlecomte@gmail.com.

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Classifications MeSH

questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie urogénitale › Procédures de chirurgie urologique › Cystectomie › Perioperative results of radical cystectomy...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Perioperative results of radical cystectomy...
questionsmedicales.fr › Thérapeutique › Association thérapeutique › Traitement néoadjuvant › Perioperative results of radical cystectomy...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Perioperative results of radical cystectomy...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Perioperative results of radical cystectomy...
questionsmedicales.fr › Appareil urogénital › Voies urinaires › Vessie urinaire › Perioperative results of radical cystectomy...
questionsmedicales.fr › Maladies urogénitales › Maladies urologiques › Tumeurs urologiques › Tumeurs de la vessie urinaire › Perioperative results of radical cystectomy...