Comparative analysis of the usage ERAS protocol after radical cystectomy

Introduction. The «gold standard» in the complex surgical treatment of muscle-invasive bladder cancer (BC) is radical cystectomy (RCE), however, early postoperative complications after it reach 70%. In this regard, the use of the protocol for accelerated recovery of patients after surgery (ERAS) in case of RCE is highly relevant from a practical and scientific point of view.The goal of the study was to compare outcomes obtained with the ERAS (enhanced recovery after surgery) protocol in patients undergoing radical cystectomy. Materials and methods: This comparative study included 132 patients (108 males (81.8%) and 24 females (18.1%)), who underwent RCE performed by the same surgeon at the Pirogov RNRMU Urology Clinic (Pirogov Municipal Clinical Hospital No. 1) from august 2011 to July 2019. Since 2015, all patients treated with radical cystectomy were managed according to the ERAS (enhanced recovery after surgery) protocol. The mean age of patients was 65.5 (32-85) years, with a men to women ratio of 5:1. To allow comparative analysis, all patients were divided into 2 groups: Group 1 was treated according to the ERAS protocol and comprised 73 patients (55.3%), while Group 2 was managed without the ERAS protocol and consisted of 59 patients (44.6%). Results: 70 complications (53%) were observed within a 90-day postoperative period: according to the Clavien-Dindo classification, grade I-II complications were seen in 40 patients (30.%), while grade III-IV complications were observed in 30 subjects (22.7%).The mortality rate within the early postoperative period (90 days) was 9.8% (13 deaths). In this study, the use of the ERAS protocol in patients undergoing RCE resulted in a 21.9% reduction in the incidence of Clavien-Dindo grade I-II complications compared with the no ERAS group (40.6%) (p function show_eabstract() { $('#eabstract1').hide(); $('#eabstract2').show(); $('#eabstract_expand').hide(); }