Presentation Authors: Adam Calaway*, Richard Foster, Yan Tong, Richard Bihrle, Timothy Masterson, Clint Cary, Indianapolis, IN
Introduction: The use of Alvimopan and multi-modality pain management in enhanced recovery after surgery (ERAS) protocols has improved outcomes after numerous surgical procedures. We sought to determine the benefits of these medications in men undergoing retroperitoneal lymph node dissection (RPLND) for testicular cancer.
Methods: A prospective pilot study of consecutive patients undergoing RPLND at a single tertiary referral center was conducted. Patients were placed in one of three interventional groups based on chronological date of surgery. The 3-drug group were managed using Alvimopan 12 mg PO prior to OR then BID until bowel movement (BM), Gabapentin 300 mg QD and Acetaminophen 1,000 q6H. The 2-drug group were managed with the above regimen excluding Alvimopan. The control group was treated per our standard pathway. Primary outcomes were length of stay, volume of IV narcotic consumed, bowel movement during hospitalization and time to resumption of bowel function. Multivariable regression models were fit to examine the association between treatment group and our primary outcomes. All the regression models included operation time (minutes), concomitant surgery (yes/no), chemotherapy (yes/no) and size of the mass (cm) as covariates. Kaplan-Meier plots were graphed for the time to bowel movement.
Results: One-hundred and fifty-two consecutive patients underwent RPLND between January 2017 and May 2018 (42 in 3-drug, 38 in 2-drug and 72 controls). Multivariable models indicated that the 3-drug (IRR 0.89, p < 0.01) and 2-drug group (IRR 0.87, p=0.02) had shorter hospital stays than the control group. Men in the 3-drug group required less narcotic pain medication than the 2-drug (-8.16, p=0.04) and the control (-8.16, p=0.03) group. Men receiving Alvimopan (3-drug) were almost 6-times more likely than the 2-drug group (p < 0.01) and 4-times more likely than the control group (p < 0.01) to resume bowel function during hospitalization. If bowel function returned during hospitalization, men in the 3-drug group had a quicker return of bowel function (p=0.045) (Figure 1).
Conclusions: The use of Alvimopan and multi-modality pain management demonstrated modest improvement in outcomes in men undergoing RPLND for testis cancer.