Is Fast Track protocol a safe tool to reduce hospitalization time after radical cystectomy with ileal urinary diversion? Initial results from a single high-volume centre

  • Daniele Romagnoli | danieleromagnoli87@gmail.com Abano Terme Hospital, Abano Terme (PD), Italy.
  • Riccardo Schiavina St. Orsola Malpighi Universitary Urology Clinic, Bologna (BO), Italy.
  • Lorenzo Bianchi
  • Marco Borghesi St. Orsola Malpighi Universitary Urology Clinic, Bologna (BO), Italy.
  • Francesco Chessa St. Orsola Malpighi Universitary Urology Clinic, Bologna (BO), Italy.
  • Federico Mineo Bianchi St. Orsola Malpighi Universitary Urology Clinic, Bologna (BO), Italy.
  • Andrea Angiolini St. Orsola Malpighi Universitary Urology Clinic, Bologna (BO), Italy.
  • Carlo Casablanca St. Orsola Malpighi Universitary Urology Clinic, Bologna (BO), Italy.
  • Marco Giampaoli Abano Terme Hospital, Abano Terme (PD, Italy.
  • Paolo Corsi Abano Terme Hospital, Abano Terme (PD), Italy.
  • Daniele D'Agostino Abano Terme Hospital, Abano Terme (PD), Italy.
  • Eugenio Brunocilla St. Orsola Malpighi Universitary Urology Clinic, Bologna (BO), Italy.
  • Angelo Porreca Abano Terme Hospital, Abano Terme (PD), Italy.

Abstract

Introduction and aim: Radical Cystectomy (RC) with ileal urinary diversion is one of the most complex urological surgical procedure, and many Fast Track (FT) protocols have been described to reduce hospitalization, without increasing postoperatory complications. We present the one-year results of a dedicated protocol developed at a high volume centre.
Materials and methods: The FT protocol was designed after a review of the literature and a multidisciplinary collegiate discussion, and it was applied to patients scheduled to open RC with intestinal urinary diversion. To validate its feasibility, we compared its results with data collected from a 1:1 matched population of patients who had undergone the same surgical procedure, without the implementation of the FT protocol.
Results: We enrolled in the FT group 11 (55%) patients scheduled to RC with ileal conduit diversion, and 9 patients (45%) scheduled to orthotopic neobladder (Studer) substitution, while a numerically equivalent population was enrolled in the control group, matched according to age at surgery, BMI, gender, ASA score, CCI, preoperative stage and type of urinary diversion. No statistically significant difference was found in terms of pre-operatory and intra-operatory domains. Median overall age was 71 years (Inter Quartile Range - IQR: 63-76) and mean operatory time was 276 ± 57 minutes. Hospitalization time was significantly reduced in the FT group, considering oralization and canalization items we found a significant advantage in the FT group. No statistically significant difference was found in the control of the post-operatory pain. We found no difference, in terms of both early and late complications ratio, among the two populations. Complications graded Clavien ≥ 3 were found in 4 patients of the control group (20%), while in only one patient (5%) in the Fast Track group, though this difference was not statistically significant.
Conclusions: The Fast Track protocol developed in this study has proven to be effective in significantly reducing hospitalization time in patients submitted to RC with intestinal urinary diversion, without increasing post-operatory complications ratio.

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Published
2020-01-14
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Section
Original Papers - Oncology
Keywords:
Radical Cystectomy, Fast Track, Enhanced Recovery After Surgery
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How to Cite
Romagnoli, D., Schiavina, R., Bianchi, L., Borghesi, M., Chessa, F., Mineo Bianchi, F., Angiolini, A., Casablanca, C., Giampaoli, M., Corsi, P., D’Agostino, D., Brunocilla, E., & Porreca, A. (2020). Is Fast Track protocol a safe tool to reduce hospitalization time after radical cystectomy with ileal urinary diversion? Initial results from a single high-volume centre. Archivio Italiano Di Urologia E Andrologia, 91(4), 230-236. https://doi.org/10.4081/aiua.2019.4.230