gms | German Medical Science

Introduction and objectives: Enhanced recovery after surgery (ERAS) concepts are implemented in various surgical disciplines. In colorectal surgery, ERAS already represents the standard of care. For patients undergoing radical cystectomy, prospective data is still rare. In the year 2014, our group could prove significant benefits of ERAS for these patients in a prospective randomized study compared to a conservative regimen in terms of postoperative morbidity, quality of life, use of analgetics, and time spent at the intermediate care unit. The current study evaluated long term follow up results of this prospective randomized study in terms of quality of life and oncological outcome.

Material and methods: Of the 101 patients who had initially prospectively been randomized to ERAS or a conservative regimen, 52 were still alive, and 35 patients could be included in the study with 21 patients in the ERAS group (60%) and 14 patients in the conservative group (40%). They had undergone radical cystectomy between 2010 and 2012. 25 patients had received urinary diversion by neobladder (71%) and 10 patients by ileal conduit (29%). Median follow-up time was 83 months (range 78-89 months). Primary endpoint assessed quality of life. For the 46 patients who had died cancer specific survival and overall survival was evaluated and compared between both groups.

Results: Five to seven years after the initial inclusion to the study there was detected no significant difference regarding quality of life parameters assessed by the EORTC questionnaire QLQ-30 (p values 0.112-0.970). The global health score was 83 in the conventional group and 79 in the ERAS group (p=0.211). Continence status was compared within the neobladder groups by ICIQ questionnaires and showed no significant differences between ERAS and conservative regimens (p=0.785). Cancer specific survival in the ERAS group did not differ significantly from CSS in the conservative group (49 vs. 58%, p=0.725).

Conclusion: Whereas ERAS represents an excellent way to improve postoperative reconvalescence and quality of life in the short-term follow up of patients undergoing radical cystectomy our data do not support that there is also a longterm effect in terms of quality of life issues. Further studies are needed to study the longterm influence of regimens such as ERAS in patients undergoing radical cystectomy or other major surgical procedures.