Reducing paralytic ileus after radical cystectomy: The role of advanced haemodynamic monitoring.

OBJECTIVE

Despite highly standardized surgical procedures, approximately 20%-30% of patients develop postoperative paralytic ileus following radical cystectomy, representing the highest incidence among abdominopelvic surgeries. The objective of this study was to identify additional predictors of paralytic ileus in a large single-centre cohort. Particular emphasis was placed on expanding the evidence regarding the effectiveness of advanced hemodynamic monitoring using the FloTrac® system.

PATIENTS AND

METHODS

We retrospectively analysed 383 patients and finally included 296 patients who underwent open or robotic radical cystectomy between 2018 and 2024 at our centre. Of these, 49 patients (16.6%) received intraoperative, minimal invasive FloTrac® monitoring. Perioperative variables were compared between groups, and predictors of paralytic ileus were determined using univariable and multivariable logistic regression analysis.

RESULTS

Paralytic ileus occurred in 23.0% of patients overall, with a significantly lower incidence in the FloTrac® group (10.2% vs. 21.3%), corresponding to a 60% relative risk reduction. In multivariable analysis, FloTrac® monitoring (OR 0.37, 95% CI 0.18-0.78, p = 0.008), female sex (OR 3.78, 95% CI 1.83-7.81, p < 0.001) and higher body weight (OR 1.04, 95% CI 1.00-1.08, p = 0.034) emerged as independent predictors. FloTrac® monitoring was further associated with reduced intraoperative blood loss and lower colloid infusion volumes. All other peri-operative and postoperative variables, including complication rates (Clavien-Dindo ≥ 3), did not differ significantly between FloTrac® and control group (p ≥ 0.05).

CONCLUSIONS

FloTrac® monitoring was independently associated with a markedly lower risk of postoperative paralytic ileus after radical cystectomy. Female sex and higher body weight were identified as additional risk factors. Our findings underscore the potential of FloTrac®-Monitoring to enhance postoperative gastrointestinal recovery for radical cystectomy. Nevertheless, overall surgical complication rates remained comparable.