title: A Prospective Randomized Trial of the Effects of Early Enteral Feeding After Radical Cystectomy.
abstract: To investigate the role of early feeding on recovery after radical cystectomy and urinary diversion. Enhanced recovery protocols have helped to standardize postoperative recovery. This is the first study to directly review the impact of early feeding on recovery in a randomized multi-institutional protocol.
  
  
  
  From 2011 to 2014, patients at 2 large hospitals were randomized after radical cystectomy to receive access to liquids and then a regular diet on postoperative days 1 and 2 or conventional care with introduction of a liquid diet after return of bowel activity, typically days 3-5. Early ambulation, use of metoclopramide, and no nasogastric tube were standard for all patients. The study was powered to detect a 50% decrease in 90-day complication rate with secondary end points of length of stay, time to bowel activity, and time to diet tolerance. The study was terminated early due to slow accrual (102 of 328).
  
  
  
  Overall complications for the early vs standard groups were similar (34 vs 31, P = .86). Immediate inpatient and postdischarge complication rates were also similar (P = .63 and P = .44). Length of stay was not different (8.74 days vs 9.69 days, P = .43). Rates of ileus (27% vs 41%, P = .21) and return of bowel function (4.67 days vs 4.09 days, P = .62) were the same in arms.
  
  
  
  Although this prospective randomized study did not meet the accrual target, early introduction of diet was well tolerated and did not show a negative or positive difference in any outcomes. Enhanced recovery protocols standardize postoperative care and early feeding is a well-tolerated addition.
authors.affiliation: Division of Urologic Surgery, University of Nebraska, Omaha, NE. Electronic address: cmdeibert@gmail.com.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Deibert
authors.affiliation: Department of Urology, New York Presbyterian-Columbia University Medical Center, New York, NY.
authors.forename: Mark V
authors.initials: MV
authors.lastname: Silva
authors.affiliation: Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: Arindam
authors.initials: A
authors.lastname: RoyChoudhury
authors.affiliation: Department of Urology, New York Presbyterian-Columbia University Medical Center, New York, NY.
authors.forename: James M
authors.initials: JM
authors.lastname: McKiernan
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York, NY.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Scherr
authors.affiliation: Institute of Human Nutrition, New York Presbyterian-Columbia University Medical Center, New York, NY.
authors.forename: David
authors.initials: D
authors.lastname: Seres
authors.affiliation: Department of Urology, New York Presbyterian-Columbia University Medical Center, New York, NY.
authors.forename: Mitchell C
authors.initials: MC
authors.lastname: Benson
mesh_terms: D015653:Cystectomy / Q000379:methods; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors; D014547:Urinary Diversion