Institute of Urology, University of Southern California, Los Angeles, CA, USA.
Institute of Urology, University of Southern California, Los Angeles, CA, USA.
Surg Oncol. 2024 Jun;54:102061. doi: 10.1016/j.suronc.2024.102061. Epub 2024 Mar 8.
Limited data are available regarding the effect of enhanced recovery after surgery (ERAS) protocols on the long-term outcomes of radical cystectomy (RC) in bladder cancer patients. The aim of this study is to evaluate the oncological outcomes in patients who underwent RC with ERAS protocol.
We reviewed the records of patients who underwent RC for primary urothelial bladder carcinoma with curative intent from January 2003 to August 2022. The primary and secondary outcomes were recurrence-free (RFS) and overall survival (OS). Multivariable Cox regression analysis was performed to evaluate the effect of ERAS on oncological outcomes.
A total of 967 ERAS patients and 1144 non-ERAS patients were included in this study. The RFS rates at 1, 3, and 5 years after RC were 81%, 71.5%, and 69% in the ERAS cohort, respectively. This rate in the non-ERAS group was 81%, 71%, and 67% at 1, 3, and 5 years after RC, respectively (P = 0.50). However, ERAS patients had significantly better OS with 86%, 73%, and 67% survival rates at 1, 3, and 5 years compared to 84%, 68%, and 59.5% survival rates in the non-ERAS group, respectively (P = 0.002). In multivariable analysis adjusting for other relevant factors, ERAS was no longer independently associated with recurrence-free (HR = 0.96, 95% CI 0.76-1.22, P = 0.75) or overall survival (HR = 0.84, 95% CI 0.66-1.09, P = 0.28) following RC.
ERAS protocols are associated with a shorter hospital stay, yet with no impact on long-term oncologic outcomes in patients undergoing RC for bladder cancer.
关于加速康复外科（ERAS）方案对膀胱癌患者根治性膀胱切除术（RC）长期结果的影响，现有数据有限。本研究旨在评估接受 ERAS 方案的 RC 患者的肿瘤学结果。
我们回顾了 2003 年 1 月至 2022 年 8 月期间因原发性尿路上皮膀胱癌接受根治性膀胱切除术且有治愈意图的患者的病历。主要和次要结局是无复发生存（RFS）和总生存（OS）。多变量 Cox 回归分析用于评估 ERAS 对肿瘤学结果的影响。
本研究共纳入 967 例 ERAS 患者和 1144 例非 ERAS 患者。RC 后 1、3 和 5 年的 RFS 率分别为 ERAS 组的 81%、71.5%和 69%，非 ERAS 组分别为 81%、71%和 67%（P=0.50）。然而，ERAS 患者的 OS 显著更好，1、3 和 5 年的生存率分别为 86%、73%和 67%，而非 ERAS 组分别为 84%、68%和 59.5%（P=0.002）。在多变量分析中，调整其他相关因素后，ERAS 与无复发生存（HR=0.96，95%CI 0.76-1.22，P=0.75）或总体生存（HR=0.84，95%CI 0.66-1.09，P=0.20）均无关。
ERAS 方案与较短的住院时间相关，但与膀胱癌患者接受 RC 后长期肿瘤学结果无关。
