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Inicio Actas Urológicas Españolas (English Edition) Influence of laparoscopic surgery on the outcomes of radical cystectomy within a...
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Vol. 48. Issue 5.
Pages 364-370 (June 2024)
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Vol. 48. Issue 5.
Pages 364-370 (June 2024)
Original article
Influence of laparoscopic surgery on the outcomes of radical cystectomy within a multimodal rehabilitation protocol
Influencia de la cirugía laparoscópica dentro de un protocolo de rehabilitación multimodal en cistectomía radical
L. Muñiz Suáreza,
Corresponding author
laura.muniz.suarez@gmail.com

Corresponding author.
, J. Subirá Ríosa, P. Gayarre Abrila, A. Montero Martorána, J.I. Hijazo Conejosa, J. García Alarcóna, J. García-Magariño Alonsoa, P. Medrano Llorentea, M. Ramírez Fabiána, F.X. Elizalde Benitoa, C. Murillo Péreza, M. Utrilla Ibuarbena, A. Asensio Matasa, C. Marín Zaldívarb, R. Casans Francésb, J.M. Ramírez Rodríguezc, B. Blasco Beltrána, P. Carrera-Lasfuentesd
a Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
b Servicio de Anestesiología y Reanimación, Hospital MAZ, Zaragoza, Spain
c Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
d Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
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Tables (4)
Table 1. Based on the ERAS guidelines, our MR protocol comprises 20 items.
Table 2. Sociodemographic and clinical characteristics.
Table 3. Outcome variables according to study group.
Table 4. Influence of laparoscopic vs. open surgery on study outcome variables. Univariate and multivariate regression models.
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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 and methods

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 (p > 0.05).

Operative time was longer in the LS group (248.4 ± 55.0 vs. 286.2 ± 51.9 min; p < 0.001). However, bleeding was significantly lower in the LS group (417.5 ± 365.7 vs. 877.9 ± 529.7 cc; p < 0.001), as was the need for blood transfusion (33.6% vs. 58.9%; p < 0.001). Postoperative length of stay (11.5 ± 10.5 vs. 20.1 ± 17.2 days; p < 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%; p = 0.237). The difference between 90-day mortality in both groups was not statistically significant (2.8% LS vs. 4.3% OS; p = 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.

Keywords:
Bladder cancer
Radical cystectomy
Enhanced recovery after surgery
ERAS
Laparoscopy
Resumen
Introducción y objetivo

Los protocolos de rehabilitación multimodal ERAS en cistectomía radical han demostrado ser útiles para mejorar los resultados en la estancia hospitalaria y las complicaciones. El objetivo de este análisis es evaluar el impacto de la cirugía laparoscópica (CL) dentro de un programa de rehabilitación multimodal.

Material y métodos

Se incluyeron en el estudio los pacientes intervenidos de cistectomía radical por cáncer vesical en un centro de tercer nivel, entre los años 2011 y 2020, según el protocolo Enhanced Recovery After Surgery (ERAS) y el Grupo Español de Rehabilitación Multimodal (GERM) con 20 ítems a cumplir.

Resultados

Se realizaron 250 cistectomías radicales durante el periodo de estudio, el 42,8% cirugía abierta (CA) y el 57,2% CL. Los grupos son comparables para las principales variables demográficas y clínicas (p > 0,05).El tiempo quirúrgico es mayor en el grupo de CL (248,4 ± 55,0 vs. 286,2 ± 51,9 min; p < 0,001). Sin embargo, el sangrado es significativamente menor en CL (417,5 ± 365,7 vs. 877,9 ± 529,7 cc; p < 0,001), así como la necesidad de transfusión (33,6 vs. 58,9%; p < 0,001). También es significativamente menor en este grupo (CL) la estancia postoperatoria (11,5 ± 10,5 vs. 20,1 ± 17,2 días; p < 0,001), y las complicaciones totales y mayores. La tasa de reingresos fue menor en el grupo de CL, pero no de forma significativa (36,4 vs. 29,4%; p = 0,237). La diferencia entre mortalidad a 90 días de ambos grupos no resulta estadísticamente significativa (2,8 CL vs. 4,3% CA; p = 0,546). Las diferencias se mantienen en los modelos multivariantes.

Conclusiones

La CL, dentro de un programa de rehabilitación multimodal, aumenta el tiempo quirúrgico, pero disminuye significativamente el sangrado intraoperatorio, la necesidad de transfusión, la estancia postoperatoria y las complicaciones.

Palabras clave:
Cáncer vesical
Cistectomía radical
Rehabilitación multimodal
ERAS
Laparoscopia

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