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

Background Radical cystectomy is associated with considerable morbidity and mortality. Based on the solid evidence in colorectal surgery, fast-track/ERAS (R) (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 (R) protocols. Materials and methods Systemic literature search and evaluation of relevant guidelines. Results The majority of ERAS (R) recommendations for radical cystectomy are based on extrapolations of abdominal surgery studies. Four randomized, controlled trials and one ERAS (R) guideline were published for radical cystectomy. ERAS (R) 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 (R) requires multidisciplinary collaboration. Individualization of an ERAS (R) program, identification of the most important components and adaption to the specific needs of radical cystectomy patients are future goals.