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Aktuelle Studienlage der Enhanced Recovery After Surgery (ERAS®) nach radikaler Zystektomie

Enhanced Recovery After Surgery (ERAS®) after radical cystectomy—current data

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Zusammenfassung

Hintergrund

Die radikale Zystektomie (RC) hat unter den urologischen Eingriffen mit die höchste Komplikationsrate. In Anlehnung an die breite, seit mehreren Jahren bestehende Evidenz in der kolorektalen Chirurgie wurden Fast-track‑/ERAS®-Protokolle („Enhanced Recovery After Surgery“) entwickelt, um die perioperative Versorgung zu verbessern.

Fragestellung

Die aktuelle Studienlage und Evidenz der einzelnen ERAS®-Bestandteile bei der RC werden beurteilt.

Material und Methoden

Es wird eine systematische Literaturrecherche unter Einbindung der aktuell gültigen Leitlinien durchgeführt.

Ergebnisse

Die meisten Empfehlungen für die RC basieren auf der Extrapolation von Studien für die Abdominalchirurgie. Insgesamt liegen 4 randomisiert-kontrollierte Studien sowie eine Leitlinie speziell für die RC vor. Unter ERAS® kann die Gesamtliegedauer verkürzt werden, ohne die Komplikationsrate zu erhöhen. Zentrale Bestandteile sind der Verzicht auf eine präoperative Darmvorbereitung, frühzeitige Entfernung der Magensonde, eine optimierte Flüssigkeitssubstitution, multimodales Schmerzmanagement, sowie eine frühzeitige Mobilisation und Kostaufbau.

Diskussion

Die Implementierung eines ERAS®-Programms bedarf einer engen multidisziplinären Zusammenarbeit. Individualisierung, Identifikation wichtiger Einzelbestandteile und die spezifische Anpassung an die RC sind zukünftige Ziele.

Abstract

Background

Radical cystectomy is associated with considerable morbidity and mortality. Based on the solid evidence in colorectal surgery, fast-track/ERAS® (Enhanced Recovery After Surgery) protocols have been developed to improve the perioperative management of patients undergoing radical cystectomy.

Objectives

To review the literature and guidelines and evaluate the evidence regarding the different components of ERAS® protocols.

Materials and methods

Systemic literature search and evaluation of relevant guidelines.

Results

The majority of ERAS® recommendations for radical cystectomy are based on extrapolations of abdominal surgery studies. Four randomized, controlled trials and one ERAS® guideline were published for radical cystectomy. ERAS® seems to shorten length of stay without increasing the complication rate. Key elements are no bowel preparation, no nasogastric tube, optimized fluid substitution, multimodal pain management, early mobilization, and oral diet.

Conclusions

Implementation of ERAS® requires multidisciplinary collaboration. Individualization of an ERAS® program, identification of the most important components and adaption to the specific needs of radical cystectomy patients are future goals.

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Authors and Affiliations

  1. Urologische Klinik und Poliklinik, LMU Klinikum München, Marchioninistr. 15, 81377, München, Deutschland

    G. B. Schulz, Y. Volz, F. Jokisch, J. Casuscelli, L. Eismann, P. Pfitzinger, C. G. Stief & B. Schlenker

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  1. G. B. Schulz
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  2. Y. Volz
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  3. F. Jokisch
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  4. J. Casuscelli
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  5. L. Eismann
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  6. P. Pfitzinger
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  7. C. G. Stief
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Corresponding author

Correspondence to G. B. Schulz.

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Interessenkonflikt

G.B. Schulz, Y. Volz, F. Jokisch, J. Casuscelli, L. Eismann, P. Pfitzinger, C.G. Stief und B. Schlenker geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Schulz, G.B., Volz, Y., Jokisch, F. et al. Aktuelle Studienlage der Enhanced Recovery After Surgery (ERAS®) nach radikaler Zystektomie. Urologe 60, 162–168 (2021). https://doi.org/10.1007/s00120-020-01435-y

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