Influence of laparoscopic surgery on the outcomes of radical cystectomy within a multimodal rehabilitation protocol.
Actas Urol Esp (Engl Ed)
; 48(5): 364-370, 2024 Jun.
Article
in En, Es
| MEDLINE
| ID: mdl-38191025
ABSTRACT
INTRODUCTION AND OBJECTIVE:
The implementation of Enhanced Recover After Surgery (ERAS) multimodal rehabilitation protocols in radical cystectomy has shown to improve outcomes in hospital stay and complications. The aim of this analysis is to evaluate the impact of laparoscopic surgery on radical cystectomy within a multimodal rehabilitation program. MATERIAL ANDMETHODS:
The study was carried out in a third level center between 2011 and 2020 including patients with bladder cancer submitted to radical cystectomy according to an ERAS (Enhanced Recovery After Surgery) protocol and the Spanish Multimodal Rehabilitation Group (GERM) with 20 items to be fulfilled.RESULTS:
A total of 250 radical cystectomies were performed throughout the study period, 42.8% by open surgery (OS) and 57.2% by laparoscopic surgery (LS). The groups are comparable in demographic and clinical variables (pâ¯>â¯0.05). Operative time was longer in the LS group (248.4⯱â¯55.0 vs. 286.2⯱â¯51.9â¯min; pâ¯<â¯0.001). However, bleeding was significantly lower in the LS group (417.5⯱â¯365.7 vs. 877.9⯱â¯529.7 cc; pâ¯<â¯0.001), as was the need for blood transfusion (33.6% vs. 58.9%; pâ¯<â¯0.001). Postoperative length of stay (11.5⯱â¯10.5 vs. 20.1⯱â¯17.2 days; pâ¯<â¯0.001), total and major complications were also significantly lower in this group (LS). The readmission rate was lower in the LS group but not significantly (36.4% vs. 29.4%; pâ¯=â¯0.237). The difference between 90-day mortality in both groups was not statistically significant (2.8% LS vs. 4.3% OS; pâ¯=â¯0.546). The differences were maintained in the multivariate models.CONCLUSIONS:
Laparoscopic surgery within a multimodal rehabilitation program increases operative time but significantly decreases intraoperative bleeding, transfusion requirements, postoperative length of stay, and complications.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Urinary Bladder Neoplasms
/
Cystectomy
/
Laparoscopy
Type of study:
Guideline
/
Prognostic_studies
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
/
Es
Journal:
Actas Urol Esp (Engl Ed)
Year:
2024
Type:
Article