[Fast-track concepts in the perioperative management of patients undergoing radical cystectomy and urinary diversion: review of the literature and research results]

Abstract

Fast-track (FT) protocols in visceral surgery incorporate innovative aspects of analgesia, bowel preparation, enteralization, and drainage management. In elective colorectal surgery, these concepts are the standard of care. In uro-oncological surgery, however, they are used very reluctantly, although the available data show that early nasogastric tube removal and enteralization and the omission of preoperative bowel preparation have positive effects on convalescence and hospital stay. The work presented here was initiated to compare traditional and FT management in a randomized fashion, focusing on complication rates and the course of enteralization as outcome measures. Complication rates, especially of bowel-associated complications, were not increased in the FT group. The postoperative stay on the intermediate care unit was significantly shorter in the FT cohort, and enteralization was completed significantly earlier. FT management is not associated with an increased risk of major complications in urinary diversion surgery. Controlled clinical trials are needed to further evaluate important aspects of a standardized perioperative plan of care (including antibiotic regimen and earlier removal of ureteral and neobladder catheters).