Enhanced Recovery After Surgery protocols for radical cystectomy surgery: review of current evidence and local protocols

AbstractBackgroundRadical cystectomy (RC) remains a morbid procedure. The use of Enhanced Recovery After Surgery (ERAS) pathways has proven to reduce care time and post‐operative complications after colorectal surgery. There is a high potential for reducing morbidity associated with RC by utilizing ERAS in this setting. The purpose of this review is to examine the current evidence for ERAS in preoperative, intra‐operative and post‐operative setting of care for RC patients and to propose ERAS evidence‐based protocol for patients undergoing RC in the Australian and New Zealand environment.PreoperativePatient's medical optimization, avoidance of oral mechanical bowel preparation and emphasis on preoperative administration of high‐energy carbohydrate drinks from colorectal literature has led to inclusion of these strategies in the preoperative considerations of ERAS in RC.Intra‐operativeEpidural analgesia has an integral role in reducing surgical stress response, improving analgesia and expediting functional recovery and should be included in ERAS RC protocols. Of relevance is 72 h maximum length of its duration. With regard to minimally invasive approach to RC, despite encouraging res