We very much agree with the idea of adding alvimopan as a standard component of the
perioperative regimen for patients undergoing radical cystectomy as proposed by the
editorial commentary. Unlike prior studies which reported the use of alvimopan at
high-volume centers, our study identified benefits of thisdrug across a wide range
of practices, most of which were relatively lower volume (IQR 5-25 cases/year). We
believe that it is among these lower volume centers where alvimopan is likely to be
most attractive because the reduced surgical volume may make it more difficult to
optimize the perioperative experience for radical cystectomy such as the multidisciplinary
efforts of enhanced recovery after surgery and prehabilitation protocols. Therefore,
while there is no single approach to reduce surgical morbidity, we believe that alvimopan
is an effective adjunct to any strategy improving the care of patients undergoing
radical cystectomy.
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© 2020 Published by Elsevier Inc.
