欧洲膀胱癌ERAS指南2013

Clinical Nutrition 32 (2013)879-887Contents lists available at ScienceDirectClinical NutritionClinical NutritionELSEVIERjournal homepage:http://www.elsevier.com/locate/cInuGuidelines for perioperative care after radical cystectomy for bladderCrossMarkcancer:Enhanced Recovery After Surgery (ERAS)societyrecommendationsYannick Cerantola a,Massimo Valerioa,Beata Persson Patrice lichlinskiaOlle Ljungqvist,Martin Hubnerd,Wassim Kassoufe,Stig Muller,Gabriele BaldiniFrancesco Carli,Torvind Naesheimh,Lars Ytrebo Arthur Revhaug',Kristoffer Lassen',Tore Knutsen*,Erling Aarsether,Peter Wiklund,Hitendra R.H.Patel*Dept of Urology.University Hospital of Lausanne,SwitzerandDept of Urology.University Hospital of Orebro,SwedenDept of Surgery.University Hospital of Orebro.SwedenDept ofVisceral Surgery.University Hospital of Lausanne.SwitzerandDept of Urology,McGill University.Montreal,CanadaDept of Urology.Akershus University Hospital,Oslo.Norway&Dept of Anesthesia,McGill University,Montreal CanadaDept of Anesthesia Intensive care.University Hospital of Northem Norway.Tromse,NorwayDept of Gl Surgery.University Hospital of Northern Norway.Tromse,NorwayDept of Urology at the Karolinska University Hospital in Stockholm,SwedenDept of Urology.University Hospital of Northem Norway.Tromse,NorwayARTICLE INFOSUMMARYArticle history:Purpose:Enhanced recovery after surgery (ERAS)pathways have significantly reduced complications andReceived 3 July 2013length of hospital stay after colorectal procedures.This multimodal concept could probably be partiallyAccepted 26 September 2013applied to major urological surgery.Objectives:The primary objective was to systematically assess the evidence of ERAS single items andprotocols applied to cystectomy patients.The secondary objective was to address a grade of recom-ERASmendation to each item,based on the evidence and,if lacking,on consensus opinion from our ERASFast-trackBladder cancerSociety working group.CystectomyEvidence acquisition:A systematic literature review was performed on ERAS for cystectomy by searchingEMBASE and Medline.Relevant articles were selected and quality-assessed by two independent re-viewers using the GRADE approach.If no study specific to cystectomy was available for any of the 22given items,the authors evaluated whether colorectal guidelines could be extrapolated.Evidence synthesis:Overall,804 articles were retrieved from electronic databases.Fifteen articles wereincluded in the present systematic review and 7 of 22 ERAS items were studied.Bowel preparation didnot improve outcomes.Early nasogastric tube removal reduced morbidity.bowel recovery time andlength of hospital stay.Doppler-guided fluid administration allowed for reduced morbidity.A quickerbowel recovery was observed with a multimodal prevention of ileus,including gum chewing,preventionof PONV and minimally invasive surgery.Condusions:ERAS has not yet been widely implemented in urology and evidence for individual in-terventions is limited or unavailable