Perioperative results of radical cystectomy after neoadjuvant chemotherapy according to the implementation of ERAS pathway

Abstract

Background: The effect of ERAS protocols in a population of radical cystectomy (RC) patients fit for neoadjuvant chemotherapy has not been specifically explored.

Objective: To compare perioperative outcomes of open RC according to the application of an ERAS protocol in a population of patients treated by cisplatin-based NAC.

Methods: All consecutive patients treated by NAC and RC between 2016 and 2019 were included. The ERAS pathway was implemented in June 2018 and followed the EAU recommendations. All data were prospectively collected. Patients' characteristics, operative outcomes, length of stay (LOS), complication rate according to Clavien-Dindo and pathological results were compared between pre- and post-ERAS. Statistical analysis was performed using R.

Results: In total, 79 patients were included, 29 in the ERAS group and 50 in the non-ERAS group. A median number of 19 out of 22 ERAS criteria were followed. Mean number of NAC cycles was 4.45 vs. 4.79 in the pre- and post-ERAS groups respectively (P=0.24). Median time between NAC and RC was 3.8months. Thirty-eight percent vs. 48% of patients received an ileal neobladder in the pre- and post-ERAS group respectively (P=0.51). No differences were observed regarding operative time, blood loss or operative transfusion rates. LOS was drastically reduced in the ERAS period (18.94 vs. 12.10days, P<0.001) as well as major (>Clavien 2) complications rate (65% vs. 28%, P=0.004).

Conclusion: ERAS drastically reduced the LOS and the rate of high-grade complications and can be effectively applied to patients receiving NAC without delaying RC.

Keywords: Chimiothérapie néoadjuvante; Complications; Complications postopératoires; Cystectomie radicale; ERAS; Neaoadjuvant chemotherapy; RAAC; Radical cystectomy.