Impact of the Multimodal Protocol on the Outcomes of Cancer Patients Undergoing Radical Cystectomy.

Authors

Mariana Athayde Petry, Camila Brandão Polakowski, Estela Iraci Rabito, Ronald Kool, Murilo Luz, Jonatas Luiz Pereira, Berenice Maria Kominek Sato, Rafaela Grossi Lombardi, Flávio Daniel Saavedra Tomasich

Published in

Revista do Colegio Brasileiro de Cirurgioes. Volume 53. Pages e2026005826. Epub Oct 26, 2026.

Abstract

The ACERTO (Acceleration of Total Postoperative Recovery) Project is a multimodal program aimed at reducing complications and accelerating postoperative recovery. These measures are particularly relevant for oncology patients undergoing major surgeries, such as radical cystectomy, which is indicated for the treatment of bladder cancer. This study evaluated the association between the ACERTO protocol and clinical outcomes in these patients.
This was a retrospective cohort study conducted through the analysis of electronic medical records of 43 patients who underwent radical cystectomy between March 2016 and October 2023. Data were collected on the elements of the ACERTO protocol and postoperative outcomes up to 30 days: surgical complications, hospital length of stay, time to first bowel movement, and readmissions.
The use of symbiotics/probiotics was associated with a lower incidence of surgical dehiscence (OR 0.03; p = 0.005) and 30-day readmission (OR 0.23; p = 0.049). Minimally invasive surgery reduced the risk of dehiscence (OR 0.13; p = 0.044) and the time to first bowel movement (p = 0.042). Restrictive intraoperative hydration showed benefits for dehiscence (p = 0.006) and urinary tract infection (p = 0.041). Early refeeding also reduced urinary tract infection (OR 0.23; p = 0.047).
Implementation of the ACERTO protocol in patients undergoing radical cystectomy demonstrated significant benefits in perioperative outcomes, reinforcing the importance of full adoption of the proposed measures.

PMID:
42961271
Bibliographic data and abstract were imported from PubMed on 30 Oct 2026.

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