Department of Urologic Oncology, University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands.
Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
World J Urol. 2018 Feb;36(2):221-229. doi: 10.1007/s00345-017-2133-2. Epub 2017 Nov 22.
Cystectomy for bladder cancer is associated with a high risk of postoperative complications. Standardized perioperative protocols, such as enhanced recovery after surgery (ERAS) protocols, aim to improve postoperative outcome. Postoperative feeding strategies are an important part of these protocols. In this two-centre study, we compared complications and length of hospital stay (LOS) between an ERAS protocol with early oral nutrition and a protocol with early enteral feeding with a Bengmark nasojejunal tube.
We retrospectively reviewed 154 consecutive patients who underwent cystectomy for bladder cancer in two hospitals (Hospital A and B) between 2014 and 2016. Hospital A uses an ERAS protocol (n = 45), which encourages early introduction of an oral diet. Hospital B uses a fast-track protocol comprising feeding with a Bengmark nasojejunal tube (Bengmark-protocol, n = 109). LOS and complications according to Clavien classification were compared between protocols.
Overall 30-day complication rates in the ERAS and Bengmark protocol were similar (64.4 and 67.0%, respectively; p = 0.463). The rate of postoperative ileus (POI) was significantly lower in the Bengmark protocol (11.9% vs. 34.4% in the ERAS protocol, p = 0.009). This association remained significant after adjustment for other variables (odds ratio 0.32, 95% confidence interval 0.11-0.96; p = 0.042). Median LOS did not differ significantly between protocols (10 days vs. 11 days in the ERAS and Bengmark protocols, respectively; p = 0.861).
Early oral nutrition in Hospital A was well tolerated. However, the Bengmark protocol was superior with respect to occurrence of POI. A prospective study may clarify whether the lower rate of POI was due to the use of early nasojejunal tube feeding or other reasons.
膀胱癌患者行膀胱切除术与术后并发症风险高相关。标准化围手术期方案，如术后加速康复（ERAS）方案，旨在改善术后结局。术后喂养策略是这些方案的重要组成部分。在这项两中心研究中，我们比较了两种方案（A 医院采用 ERAS 方案，鼓励早期口服营养；B 医院采用含 Bengmark 鼻空肠管的快速通道方案）之间的并发症和住院时间（LOS）。
我们回顾性分析了 2014 年至 2016 年间两家医院（A 医院和 B 医院） 154 例连续膀胱癌患者的资料。A 医院采用 ERAS 方案（n=45），鼓励早期口服饮食。B 医院采用含 Bengmark 鼻空肠管的快速通道方案（Bengmark 方案，n=109）。比较两种方案的 LOS 和 Clavien 分级并发症。
ERAS 方案和 Bengmark 方案的 30 天术后并发症发生率相似（分别为 64.4%和 67.0%，p=0.463）。Bengmark 方案的术后肠梗阻（POI）发生率明显较低（11.9%比 ERAS 方案的 34.4%，p=0.009）。调整其他变量后，这种关联仍然显著（比值比 0.32，95%置信区间 0.11-0.96；p=0.042）。两种方案的 LOS 中位数无显著差异（分别为 10 天和 11 天，p=0.861）。
A 医院的早期口服营养耐受良好。然而，Bengmark 方案在 POI 发生率方面更具优势。前瞻性研究可能阐明 POI 发生率较低是否归因于早期使用鼻空肠管喂养或其他原因。
