Revista do Colégio Brasileiro de Cirurgiões
http://www.rcbc.periodikos.com.br/article/doi/10.1590/0100-6991e-2026005826
Revista do Colégio Brasileiro de Cirurgiões
Original Article

Impacto do protocolo multimodal nos desfechos de pacientes com câncer submetidos à cistectomia radical

Impact of the Multimodal Protocol on the Outcomes of Cancer Patients Undergoing Radical Cystectomy

Mariana Athayde Petry; Camila Brandão Polakowski; Estela Iraci Rabito; Ronald Kool; Murilo Luz; Jonatas Luiz Pereira; Berenice Maria Kominek Sato; Rafaela Grossi Lombardi; Flávio Daniel Saavedra Tomasich

http://dx.doi.org/10.1590/0100-6991e-2026005826 RCBC, vol.53, e2026005826, 2026
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Resumo

Introdução: O Projeto ACERTO (Aceleração da Recuperação Total Pós-Operatória) é um programa multimodal que visa reduzir complicações e acelerar a recuperação pós-operatória. Tais cuidados são especialmente relevantes em pacientes oncológicos submetidos a cirurgias de grande porte, como a cistectomia radical, indicada para o tratamento do câncer de bexiga. Este estudo avaliou a associação entre o protocolo ACERTO e os desfechos clínicos desses pacientes.

Métodos: Estudo de coorte retrospectivo, por meio da análise de prontuários eletrônicos de 43 pacientes submetidos à cistectomia radical entre março de 2016 e outubro de 2023. Foram coletados dados referentes aos elementos do protocolo ACERTO e aos desfechos até 30 dias de pós-operatório: complicações cirúrgicas, tempo de internação hospitalar, tempo até a primeira evacuação e readmissões.

Resultados: O uso de simbióticos/probióticos foi associado à menor incidência de deiscência cirúrgica (OR 0,03; p=0,005) e readmissão em até 30 dias (OR 0,23; p=0,049). A cirurgia minimamente invasiva reduziu o risco de deiscência (OR 0,13; p=0,044) e o tempo até a primeira evacuação (p=0,042). A hidratação intraoperatória restrita foi benéfica para deiscência (p=0,006) e infecção do trato urinário (p=0,041). A retomada precoce da alimentação também reduziu a infecção do trato urinário (OR 0,23; p=0,047).

Conclusão: A implementação do protocolo ACERTO em pacientes submetidos à cistectomia radical demonstrou benefícios significativos nos desfechos perioperatórios, reforçando a importância da adoção integral das medidas propostas.

Palavras-chave

Cuidados Perioperatórios; Neoplasias de Bexiga Urinária; Terapia Nutricional; Cistectomia

Abstract

Introduction: The ACERTO (Acceleration of Total Postoperative Recovery) Project is a multimodal program aimed at reducing complications and accelerating postoperative recovery. These measures are particularly relevant for oncology patients undergoing major surgeries, such as radical cystectomy, which is indicated for the treatment of bladder cancer. This study evaluated the association between the ACERTO protocol and clinical outcomes in these patients.

Methods: This was a retrospective cohort study conducted through the analysis of electronic medical records of 43 patients who underwent radical cystectomy between March 2016 and October 2023. Data were collected on the elements of the ACERTO protocol and postoperative outcomes up to 30 days: surgical complications, hospital length of stay, time to first bowel movement, and readmissions.

Results: The use of symbiotics/probiotics was associated with a lower incidence of surgical dehiscence (OR 0.03; p = 0.005) and 30-day readmission (OR 0.23; p = 0.049). Minimally invasive surgery reduced the risk of dehiscence (OR 0.13; p = 0.044) and the time to first bowel movement (p = 0.042). Restrictive intraoperative hydration showed benefits for dehiscence (p = 0.006) and urinary tract infection (p = 0.041). Early refeeding also reduced urinary tract infection (OR 0.23; p = 0.047).

Conclusion: Implementation of the ACERTO protocol in patients undergoing radical cystectomy demonstrated significant benefits in perioperative outcomes, reinforcing the importance of full adoption of the proposed measures.

Keywords

Perioperative Care; Urinary Bladder Neoplasms; Nutrition Therapy; Cystectomy

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Submitted date:
05/12/2026

Accepted date:
08/17/2026

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