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Introduction:
Radical cystectomy, while being the gold standard treatment for muscle-invasive cancer, is associated with significant morbidity, with rates of gastrointestinal complications being reported as high as 20%. Alvimopan is a peripherally-acting, mu-opioid receptor antagonist that has been shown in randomized-control trials to accelerate gastrointestinal recovery in patients undergoing bowel resection with primary anastamosis. We report our experience with gastrointestinal recovery for patients undergoing cystectomy with urinary diversion treated with alvimopan.
Materials & Methods:
From 1/2008 to 3/2011, 41 consecutive patients underwent radical cystectomy with urinary diversion performed by a single surgeon. The first 25 patients in our study did not receive alvimopan and were kept with nasogastric-decompression until return of flatus. The latter 16 patients received perioperative alvimopan and were without postoperative nasogastric-decompression.
Results:
Time to first flatus (3.2 vs 5.6 days,p=<0.01) and bowel movement (3.7 vs 6.0 days,p=<0.01) were significantly shorter in those patients who received alvimopan. Additionally, initiation of clear liquid (4.2 vs 6.3 days) and regular diet (5.9 vs 7.3 days p=<0.01) were accelerated in the alvimopan cohort. There were no incidences of prolonged ileus in those patients who received perioperative alvimopan (0% vs 24%,p=0.03).
Conclusions:
Urinary diversion status post radical cystectomy is associated with significant gastrointestinal morbidity. In our experience, the use of alvimopan perioperatively significantly accelerates the rate of GI recovery and reduces the incidence of post-operative ileus.