Outcomes of an enhanced recovery after radical cystectomy program in a prospective multicenter study: compliance and key components for success.

OBJECTIVE: To investigate the effect of an Enhanced Recovery After Surgery (ERAS) program on complications and length of stay (LOS) after radical cystectomy (RC) and to assess if the number and type of components of ERAS play a key role on the decrease of surgical morbidity. MATERIALS AND METHODS: We analyzed the data of 277 patients prospectively recruited in 11 hospitals undergoing RC initially managed according to local practice (Group I) and later within an ERAS program (Group II). Two main outcomes were defined: 90-day complications rate and LOS. As secondary variables we studied 90-day mortality, 30-day readmission and transfusion rate. RESULTS: Patients in Group II had a higher use of ERAS measures (98.6%) than those in Group I (78.2%) (p < 0.05). Patients in Groups I and II experienced similar complications (70.5% vs. 66%, p = 0.42). LOS was not different between Groups I and II (12.5 and 14 days, respectively, p = 0.59). The risk of having any complication decreases for patients having more than 15 ERAS measures adopted [RR = 0.815; 95% confidence interval (CI) 0.667-0.996; p = 0.045]. Avoidance of transfusion and nasogastric tube, prevention of ileus, early ambulation and a fast uptake of a regular diet are independently associated with the absence of complications. CONCLUSIONS: Complications and LOS after RC were not modified by the introduction of an ERAS program. We hypothesize that at least 15 measures should be applied to maximize the benefit of ERAS.

[Collecting duct renal cell carcinoma]. / Carcinoma de células renales del túbulo colector.

INTRODUCTION: Bellini's renal cell collecting duct carcinoma is a rarely prevalent renal tumour, with low cancer-specific survival, although its rate of response to antiangiogenic therapies is unknown. OBJECTIVES: We retrospectively revise a series of collecting duct tumours, with special emphasis on the indication of target therapies and on their results. MATERIALS AND METHODS: Retrospective analysis of renal cell collecting duct carcinoma treated at our institution from January 2000 to June 2010, taking into account the patient's age, sex, reason for the consultation, oncological background, side of the affection, surgical treatment, other anatomopathological characteristics, tumour size, TNM clinical staging (2009), adjuvant treatment and survival time. RESULTS: Six patients are described, five men and one woman, with a mean age of 75 (± 7.7) years. Four of them (66.6%) presented disseminated disease upon diagnosis. Five (83%) were treated with radical nephrectomy and three (50%) received systemic adjuvant treatment, without response. The means survival was 5.5 months (4.75-14.75). Only 2 patients (33.3%), both with localized disease upon diagnosis, are in complete remission. CONCLUSION: Renal cell collecting duct carcinoma is a disease with a bad prognosis, little survival and bad response to target therapies.