الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Bladder cancer is one of the most frequent solid tumors in Western world, and is the second most common urologic malignancy.
The treatment usually is a combination of high-quality surgery; radical cystectomy with urinary diversion and chemo-radiotherapy. Open or laparoscopic surgery is a controlled trauma which has a stress response and immunological consequences with the most important change is insulin resistance. In order to reduce the stress response to surgery and its sequels the recent concept of enhanced recovery after major elective surgery started to appear for the first time in 1990 as a revolutionary change that seen in the anesthesia practice associated with the appearance of regional techniques to control the perioperative pain.
Enhanced recovery after surgery (ERAS) protocols are evidence-based programs established to normalize and optimize perioperative medical care aiming to decrease surgical trauma, perioperative physiological stress and organ dysfunction associated with elective surgeries. Diabetic patients are considered as high risk population during surgery with extended hospital stays, higher postoperative complications. They are important candidate for implanting the ERAS program.
Aim of the work
The aim of the present study is to evaluate the efficacy of Enhanced Recovery after Surgery protocol for radical cystectomy surgery in diabetic patients as regard length of hospital stay, blood sugar control in ERAS and time to bowel activity.
Patients
All patients were of American Society of Anesthesiology (ASA) physical status II, III. They were admitted to Alexandria Main University hospital, and were scheduled for radical cystectomy surgeries under the effect of general anesthesia combined with epidural analgesia after taking approval of the local Ethical Committee, and a written consent from every patient involved in the study.