Indian Journal of Urology
LETTER TO EDITOR
Year
: 2020  |  Volume : 36  |  Issue : 3  |  Page : 240--241

Author Reply Re: Bansal D, Nayak B, Singh P, Nayyar R, Ramachandran R, Kumar R, Seth A. Randomized controlled trial to compare outcomes with and without the enhanced recovery after surgery protocol in patients undergoing radical cystectomy. Indian J Urol 2020;36:95-100


Devanshu Bansal1, Brusabhanu Nayak2, Prabhjot Singh2, Rishi Nayyar2, Rashmi Ramachandran3, Rajeev Kumar2, Amlesh Seth2,  
1 Department of Urology, Uro-Oncology and Renal Transplant, Max Hospital, New Delhi, India
2 Department of Urology, All India Institute of Medical Sciences, New Delhi, India
3 Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Dr. Brusabhanu Nayak
Department of Urology, All India Institute of Medical Sciences, New Delhi
India




How to cite this article:
Bansal D, Nayak B, Singh P, Nayyar R, Ramachandran R, Kumar R, Seth A. Author Reply Re: Bansal D, Nayak B, Singh P, Nayyar R, Ramachandran R, Kumar R, Seth A. Randomized controlled trial to compare outcomes with and without the enhanced recovery after surgery protocol in patients undergoing radical cystectomy. Indian J Urol 2020;36:95-100.Indian J Urol 2020;36:240-241


How to cite this URL:
Bansal D, Nayak B, Singh P, Nayyar R, Ramachandran R, Kumar R, Seth A. Author Reply Re: Bansal D, Nayak B, Singh P, Nayyar R, Ramachandran R, Kumar R, Seth A. Randomized controlled trial to compare outcomes with and without the enhanced recovery after surgery protocol in patients undergoing radical cystectomy. Indian J Urol 2020;36:95-100. Indian J Urol [serial online] 2020 [cited 2020 Sep 27 ];36:240-241
Available from: http://www.indianjurol.com/text.asp?2020/36/3/240/288627


Full Text



We thank the authors for their kind appreciation and keen observations. We performed a randomized controlled trial assessing enhanced recovery after surgery (ERAS) protocol for patients undergoing radical cystectomy in the Indian setting.[1] Our study population included patients undergoing both ileal conduit (51 patients) and neobladder formation (3 patients). As the authors suggest, the patients undergoing neobladder formation are logically expected to have a longer operative time and delayed bowel recovery compared to patients undergoing ileal conduit. However, the aim of the current study was not to compare the outcome of patients undergoing ileal conduit versus neobladder formation. Because only three patients underwent neobladder formation at our center during our study period, a subgroup analysis was not done. In addition, stratified randomization of the patients would have been required in that case. However, a prospective study may be planned to evaluate that aspect.

One patient in our study had cT4b disease on exploration and underwent bilateral ureterostomy formation. We do agree with the authors that neoadjuvant chemotherapy followed by cystectomy is the ideal option in locally advanced cases. However, in real-life scenario, it is not always feasible to give neoadjuvant chemotherapy in every case. In this case, the disease looked resectable on preoperative clinical examination and cross-sectional imaging. However, intraoperatively, the patient was found to have an unresectable disease. Because the patient was planned for chemotherapy afterward, bilateral ureterostomy was done to preserve both the functioning kidneys so as to preserve maximum renal function.

We routinely perform open radical cystectomy at our center. We agree that the use of minimally invasive technique with intracorporeal conduit formation is another component of the ERAS protocol and can further help to reduce the morbidity of the procedure, as supported by recent single-institution studies.[2],[3] However, further multi-institutional research with larger sample size is required for a definitive answer.

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.

References

1Bansal D, Nayak B, Singh P, Nayyar R, Ramachandran R, Kumar R, et al. Randomized controlled trial to compare outcomes with and without the enhanced recovery after surgery protocol in patients undergoing radical cystectomy. Indian J Urol 2020;36:95.
2Tamhankar AS, Ahluwalia P, Patil SR, Nambiath S, Gautam G. Implementation of ERAS protocol in robot-assisted radical cystectomy with intracorporeal ileal conduit urinary diversion: An outcome analysis beyond the learning curve. Indian J Urol 2020;36:37-43.
3Khan MS, Omar K, Ahmed K, Gan C, van Hemelrijck M, Nair R, et al. Long-term oncological outcomes from an early phase randomised controlled three-arm trial of open, robotic, and laparoscopic radical cystectomy (CORAL). Eur Urol 2020;77:110-8.