Putting Evidence to Practice in the Management of Patients Submitted to Radical Cystectomy: Outcomes from a National Survey

Introduction:Radical cystectomy (RC) is recognized as the standard gold treatment for patients with high-risk muscle-invasive bladder cancer (MIBC) and non-MIBC (NMIBC). Admission and adoption of early recovery protocols following RC (ERPRC) are highly variable throughout the world. We sought to examine current practice patterns and adherence to early improvement pathways in the perioperative management of RC through a survey administered to national urologists.Methods: We conducted a multicenter cross-sectional study through a survey that addressed different components of the ERPRC. Two authors (ABS and JNP) reviewed the available ERPRC evidence. The questionnaire included ۲۴ questions. Participants provided consent, and their anonymity was assured.Results: Sixty-six responses were gathered from ۱۷ centers. ۶۴% of the respondents mentioned not having a formal ERPRC in their center. However, high-volume cases showed a significantly higher ERPRC implementation rate (۵۱.۵% vs. ۱۰.۵% vs. ۰%, P-value<۰.۰۵). In the preoperative period, anemia correction and avoidance of bowel preparation were the most implemented steps. Intraoperatively, urologists tend to follow ERPRC recommendations in the postoperative period. No statistically significant differences were found in ERPRC components adopted in the perioperative period and the median length of hospital stay (۹ days, P-value=۰.۰۹), irrespective of surgical center volume. ERPRC is agreed by ۷۷% of urologists to be useful or very useful for achieving better outcomes.Conclusions: Although most of the urologists pointed out that ERPRC was not formally implemented at their center, most parts indicated that ERPRC significantly improved outcomes during RC PO and, therefore, were followed.

Keywords:

Bladder Cancer , Muscle-Invasive Bladder Cancer , Early Recovery After Surgery , ERAS , protocol