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Mr JM Patterson, Mr M Malki , Mr MD Haynes, Mr DJP Rosario and Mr JWF Catto

An assessment of the complications of open radical cystectomy with and without naso-gastric tubes – is a naso-gastric tube still routinely required?. Mr JM Patterson, Mr M Malki , Mr MD Haynes, Mr DJP Rosario and Mr JWF Catto Academic Urology Unit, University of Sheffield

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Mr JM Patterson, Mr M Malki , Mr MD Haynes, Mr DJP Rosario and Mr JWF Catto

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  1. An assessment of the complications of open radical cystectomy with and without naso-gastric tubes – is a naso-gastric tube still routinely required? Mr JM Patterson, Mr M Malki, Mr MD Haynes, Mr DJP Rosario and Mr JWF Catto Academic Urology Unit, University of Sheffield and Department of Urology, Royal Hallamshire Hospital Sheffield Teaching Hospitals NHS Foundation Trust

  2. Introduction • Cystectomy is a morbid procedure • RT, GIT and UT/renal complications; mortality • Patients dislike nasogastric tubes and they are associated with respiratory complications • ERAS protocols have been introduced to improve LoS and other morbidity factors • Can morbidity be reduced by removing the routine use of NGT?

  3. Methods and patients • Null hypothesis: Not using NGT will prolong ileus and increase complications • Prospective evaluation of 57 patients undergoing open radical cystectomy • Single institution, 3 surgeons • 2 surgeons stopped placing NGT, 1 continued • 12 month study period, followed up for 6-18 months

  4. Methods and patients • Final pathology: • 15 pT0, 9 pTis, 3 pTa, 4 pT1, 15 pT2, 7 pT3, 4 pT4. • 13 N+ (4 pN1, 8* pN2, 1 pN3) *including an incidental lymphoma in pelvic nodes • 1 M+ (separate vaginal nodule to main tumour-G3pT2). • 11 incidental CaP • 53 Urothelial Ca (+2 Neuroendocrine differentiated), 1 AdenoCa, 1 SqCCa • 2 primary urethrectomy, 1 salvage cystectomy. All ♀ done as ant. exenteration

  5. Results • No difference in LoS (orthotopics excluded) • No difference in time to return of GIT transit • No difference in rates of DVT/PE or wound dehiscence (nil both groups), or cardiovascular or stomal complications • However, other complications do differ

  6. Results • Complications • 1 death in each group • 188 days post op in NGT- group – pT4 disease, 79yo • 159 days post op in NGT+ group – post salvage surgery, complications included enterocutaneous fistulae, T3b sarcomatoid tumour, 72yo • NGT related • 4 inserted in NGT- group (19%) • 2 only for 24h, 1 for chronic constipation, 1 for ileus • 4 reinserted in NGT+ group (11%) • 1 resited in PACU, 2 for 24-48h only, 1 for SB complications

  7. Results • Complications

  8. Discussion • No result statistically significant • Trend towards more complications in longer operations (mean duration 5.3 v 4.9h without complication), paralleled by blood loss • NGT negatively associated with • respiratory complications • wound infections • overall complications

  9. Conclusions • Routine NGT placement after open radical cystectomy is not recommended • increased complications in this series • but up to 20% may need NGT insertion • senior clinician decision to avoid unnecessary NGT • Longer operating times seem to be correlated with blood loss, and increased complications

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