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Erschienen in: Die Urologie 2/2021

13.01.2021 | Harnblasenkarzinom | Leitthema

Aktuelle Studienlage der Enhanced Recovery After Surgery (ERAS®) nach radikaler Zystektomie

verfasst von: PD Dr. G. B. Schulz, Y. Volz, F. Jokisch, J. Casuscelli, L. Eismann, P. Pfitzinger, C. G. Stief, B. Schlenker

Erschienen in: Die Urologie | Ausgabe 2/2021

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Zusammenfassung

Hintergrund

Die radikale Zystektomie (RC) hat unter den urologischen Eingriffen mit die höchste Komplikationsrate. In Anlehnung an die breite, seit mehreren Jahren bestehende Evidenz in der kolorektalen Chirurgie wurden Fast-track‑/ERAS®-Protokolle („Enhanced Recovery After Surgery“) entwickelt, um die perioperative Versorgung zu verbessern.

Fragestellung

Die aktuelle Studienlage und Evidenz der einzelnen ERAS®-Bestandteile bei der RC werden beurteilt.

Material und Methoden

Es wird eine systematische Literaturrecherche unter Einbindung der aktuell gültigen Leitlinien durchgeführt.

Ergebnisse

Die meisten Empfehlungen für die RC basieren auf der Extrapolation von Studien für die Abdominalchirurgie. Insgesamt liegen 4 randomisiert-kontrollierte Studien sowie eine Leitlinie speziell für die RC vor. Unter ERAS® kann die Gesamtliegedauer verkürzt werden, ohne die Komplikationsrate zu erhöhen. Zentrale Bestandteile sind der Verzicht auf eine präoperative Darmvorbereitung, frühzeitige Entfernung der Magensonde, eine optimierte Flüssigkeitssubstitution, multimodales Schmerzmanagement, sowie eine frühzeitige Mobilisation und Kostaufbau.

Diskussion

Die Implementierung eines ERAS®-Programms bedarf einer engen multidisziplinären Zusammenarbeit. Individualisierung, Identifikation wichtiger Einzelbestandteile und die spezifische Anpassung an die RC sind zukünftige Ziele.
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Metadaten
Titel
Aktuelle Studienlage der Enhanced Recovery After Surgery (ERAS®) nach radikaler Zystektomie
verfasst von
PD Dr. G. B. Schulz
Y. Volz
F. Jokisch
J. Casuscelli
L. Eismann
P. Pfitzinger
C. G. Stief
B. Schlenker
Publikationsdatum
13.01.2021
Verlag
Springer Medizin
Erschienen in
Die Urologie / Ausgabe 2/2021
Print ISSN: 2731-7064
Elektronische ISSN: 2731-7072
DOI
https://doi.org/10.1007/s00120-020-01435-y

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