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.