Optimal nutrition should improve the outcome and costs of radical cystectomy

Introduction: Nutritional support has been demonstrated to improve recovery from radical cystectomy, but is expensive and when used inappropriately may actually increase the costs and morbidity of surgery. We sought to establish national patterns of practice with regard to feeding following cystectomy in the UK. Aims and Methods: Following consultation with the specialist nutrition team, a questionnaire was designed to investigate the feeding strategy after cystectomy and dispatched by post to all UK urologists. Results: The majority (60%) of respondents employed a traditional strategy of resting the bowel and feeding orally after bowel recovery. A minority used either early total parenteral nutrition (TPN; 18.5%) or enterai nutrition (6.5%), but a larger proportion (29%) felt enterai nutrition was the 'optimal' feeding regime. Only 30% used guidelines and 52% felt trials would help to establish a nutrition strategy following cystectomy. Conclusion: There is little evidence that TPN improves the outcome of cystectomy and it may actually increase morbidity and costs, whereas enterai nutrition may improve recovery. Despite this evidence TPN is widely used by urologists whereas enterai nutrition is used infrequently. Implementation of an evidence-based feeding regime after cystectomy is likely to reduce the morbidity and financial costs of cystectomy.