Efficacy of a multiprofessional rehabilitation programme in radical cystectomy pathways: a prospective randomized controlled trial

Abstract

Introduction: Radical cystectomy with lymph-node dissection is a complex procedure and often followed by high postoperative morbidity and physical impairments leading to prolonged length of stay (LOS). Fast-track principles are standard procedure in radical cystectomy. Additional preoperative and postoperative physical exercises and enhanced mobilization may reduce LOS and early complications.

Materials and methods: In total, 107 patients were included in a prospective randomized controlled design, 50 in the intervention group (nI = 50) and 57 in the standard group (ns = 57). The standard regimen comprised regular fast-track principles. The intervention included standardized preoperative and postoperative strength and endurance exercises and progressive postoperative mobilization. The programme was initiated 2 weeks before surgery. Efficacy was expressed as a reduction in postoperative LOS. Early complications were defined as events occurring at most 90 days postoperatively and graded using the Clavien-Dindo classification system.

Results: Adherence to prehabilitation, i.e. patients who accomplished at least 75% of the programme, was 59%. Postoperative mobilization was significantly improved by walking distance (p ≤ 0.001). The ability to perform personal activities of daily living was improved by 1 day (p ≤ 0.05). The median LOS was 8 days in both treatment groups (p = 0.68). There was no significant difference between treatment groups in severity of complications (p = 0.64).

Conclusions: There was no reduction in LOS due to the preoperative and postoperative rehabilitation programme, although enhanced mobilization was achieved. The optimized minimal surgical procedure may have affected the ability to reduce LOS further with available techniques and procedures. Alternative parameters for recovery may offer more precise and relevant information.

Keywords: bladder cancer; complication; enhanced recovery programme; physical exercise; prehabilitation; radical cystectomy; rehabilitation.