Multimodal Perioperative Plan for Radical Cystectomy and Intestinal Urinary Diversion. I. Effect on Recovery of Intestinal Function and Occurrence of Complications

Massimo Maffezzini, Guido Gerbi, Fabio Campodonico, Donatella Parodi

Research output: Contribution to journalArticle

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Abstract

Objectives: To discuss a multimodal perioperative plan aimed at reducing postoperative ileus and complications associated with radical cystectomy and urinary reconstruction. Methods: The protocol consisted of preoperative, intraoperative, and postoperative measures. The clinical parameters assessed were the time to the return of bowel movements, the presence and duration of postoperative ileus, the presence and duration of an intolerance to oral feeding, the interval to re-institution of a regular diet, and complications. The biochemical parameters (serum total protein and albumin levels and lymphocyte counts) were also assessed. A sample of 40 patients treated before the implementation of this protocol was included for comparison. Results: A total of 71 patients, mean age 74 years and American Society of Anesthesiologists status 2 and 3, consecutively underwent radical surgery for bladder cancer and were evaluable for results and complications. Urinary diversion was a heterotopic neobladder in 27 patients (38%), orthotopic in 23 (32.3%), and an ileal conduit in 21 (29.5%). Bowel movements returned after a median of 2 days (range 1 to 6), intolerance to oral feeding was observed in 17 (23.9%) of 71 patients, and the median time to re-institution of a regular diet was 4 days (range 3 to 9). The complication rate was 26.7%, and the mortality rate was 4.2%. No effects were observed on postoperative protein depletion. In the historical group, the median time to diet resumption was 8 days (range 7 to 12). Conclusions: A short time to the resumption of normal intestinal function and a low incidence of postoperative ileus after cystectomy was observed. However, the incidence of postoperative protein depletion was unaffected. Additional studies should address this subject.

Original languageEnglish
Pages (from-to)1107-1111
Number of pages5
JournalUrology
Volume69
Issue number6
DOIs
Publication statusPublished - Jun 2007

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Urinary Diversion
Cystectomy
Recovery of Function
Ileus
Diet
Incidence
Lymphocyte Count
Urinary Bladder Neoplasms
Serum Albumin
Blood Proteins
Proteins
Mortality

ASJC Scopus subject areas

  • Urology

Cite this

Multimodal Perioperative Plan for Radical Cystectomy and Intestinal Urinary Diversion. I. Effect on Recovery of Intestinal Function and Occurrence of Complications. / Maffezzini, Massimo; Gerbi, Guido; Campodonico, Fabio; Parodi, Donatella.

In: Urology, Vol. 69, No. 6, 06.2007, p. 1107-1111.

Research output: Contribution to journalArticle

Maffezzini, Massimo ; Gerbi, Guido ; Campodonico, Fabio ; Parodi, Donatella. / Multimodal Perioperative Plan for Radical Cystectomy and Intestinal Urinary Diversion. I. Effect on Recovery of Intestinal Function and Occurrence of Complications. In: Urology. 2007 ; Vol. 69, No. 6. pp. 1107-1111.
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abstract = "Objectives: To discuss a multimodal perioperative plan aimed at reducing postoperative ileus and complications associated with radical cystectomy and urinary reconstruction. Methods: The protocol consisted of preoperative, intraoperative, and postoperative measures. The clinical parameters assessed were the time to the return of bowel movements, the presence and duration of postoperative ileus, the presence and duration of an intolerance to oral feeding, the interval to re-institution of a regular diet, and complications. The biochemical parameters (serum total protein and albumin levels and lymphocyte counts) were also assessed. A sample of 40 patients treated before the implementation of this protocol was included for comparison. Results: A total of 71 patients, mean age 74 years and American Society of Anesthesiologists status 2 and 3, consecutively underwent radical surgery for bladder cancer and were evaluable for results and complications. Urinary diversion was a heterotopic neobladder in 27 patients (38{\%}), orthotopic in 23 (32.3{\%}), and an ileal conduit in 21 (29.5{\%}). Bowel movements returned after a median of 2 days (range 1 to 6), intolerance to oral feeding was observed in 17 (23.9{\%}) of 71 patients, and the median time to re-institution of a regular diet was 4 days (range 3 to 9). The complication rate was 26.7{\%}, and the mortality rate was 4.2{\%}. No effects were observed on postoperative protein depletion. In the historical group, the median time to diet resumption was 8 days (range 7 to 12). Conclusions: A short time to the resumption of normal intestinal function and a low incidence of postoperative ileus after cystectomy was observed. However, the incidence of postoperative protein depletion was unaffected. Additional studies should address this subject.",
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