A Multimodal Perioperative Plan for Radical Cystectomy and Urinary Intestinal Diversion: Effects, Limits and Complications of Early Artificial Nutrition

Maffezzini, Massimo; Gerbi, Guido; Campodonico, Fabio; Parodi, Donatella

doi:10.1016/j.juro.2006.04.076

Cited by 29 publications

(25 citation statements)

References 17 publications

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“…A recent prospective analysis of 28 RC patients demonstrated that the use of a combination protocol of TPN and enteral nutrition was not effective at reducing post-operative ileus and did not prevent the decline of serum chemistry markers such as serum albumin 28. However, this study’s power to detect a difference in complication rates or surrogate markers may be limited because the researchers did not target an at-risk population and because of the small sample size.…”

Section: Discussionmentioning

confidence: 92%

Effect of Preoperative Nutritional Deficiency on Mortality After Radical Cystectomy for Bladder Cancer

et al. 2011

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Introduction and Objectives Poor preoperative nutritional status is a risk factor for adverse outcomes after major surgery. We evaluated the effect of preoperative nutritional deficiency (ND) on peri–operative mortality and overall survival in patients undergoing radical cystectomy (RC) for bladder cancer. Methods 538 patients underwent RC for urothelial carcinoma (UC) between January 2000 and June 2008 and had nutritional parameters documented. Patients with preoperative albumin <3.5 g/dL, BMI <18.5 or pre–surgical weight loss >5% of body weight were considered ND. Primary outcomes were 90–day mortality and overall survival. Survival was estimated using Kaplan–Meier analysis and compared using the log–rank test. Cox proportion hazards models were used for multivariate survival analysis. Results 103 of 538 patients (19%) met criteria for ND. 90–day mortality was 7.3% overall (39 deaths); 16.5% in patients with ND and 5.1% in the others, p<0.01..ND was a strong predictor of death within 90 days on multivariate analysis (HR 2.91, 95% CI [1.36, 6.23], p<0.01). Overall survival at 3 years was 44.5% (33.5, 54.9) for ND patients and 67.6% (62.4, 72.2) for nutritionally normal patients, p<0.01. On multivariate analysis, ND patients had significantly higher risk of all-cause mortality (HR 1.82, 95% CI [1.25, 2.65], p<0.01). Conclusions Nutritional deficiency, as measured by preoperative weight loss, BMI and serum albumin, is a strong predictor of 90–day mortality and poor overall survival. Prospective studies are needed to demonstrate the best indices of preoperative nutritional status and whether nutritional intervention can alter the poor prognosis for RC patients with nutritional deficiencies.

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Section: Discussionmentioning

confidence: 92%

Effect of Preoperative Nutritional Deficiency on Mortality After Radical Cystectomy for Bladder Cancer

et al. 2011

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“…Maffezzini et al. devised a novel peri‐operative pathway in RC, with similar principles to those of an ERAS protocol . Patients had bladder reconstruction using intestinal segments (e.g.…”

Section: Methodsmentioning

confidence: 99%

“…The main study aim was to minimize the impact of major urological ablative and reconstructive surgery in an elderly population, with significant comorbidities . Clinical outcomes focused on postoperative bowel function and protein depletion . The initial trials demonstrated a quicker return to normal bowel function.…”

Section: Methodsmentioning

confidence: 99%

Malnourishment in bladder cancer and the role of immunonutrition at the time of cystectomy: an overview for urologists

et al. 2014

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• The 'gold standard' treatment for patients with carcinoma invading the bladder muscle is radical cystectomy (RC). Such patients are known to be at risk of malnutrition because of age and disease factors. Current evidence has established the nutritional and immunological benefits of immune-enhancing nutritional supplements in upper gastrointestinal surgery. There are currently no guidelines for immunonutrition (IM) use in urology and bladder cancer specifically.• We carried out a systematic review of the available literature in the MEDLINE/Embase database. We assessed the rates of malnutrition in RC cohorts and analysed the clinical impacts of nutritional deficiency. The impact of immune-enhancing supplements was also investigated in RC cohorts with regard to postoperative outcomes.• The prevalence of severe malnutrition was found to be 16-22%. There was a consistent association of malnourished patients with adverse postoperative outcomes in terms of mortality and morbidity. There is a paucity of data regarding IM in urological cohorts. Postoperative IM in RC was not found to have significant benefits beyond early return to a normal diet.• There is not enough evidence in malnourished urological study cohorts to establish a consensus on IM. Until there are more well-controlled comparative effective studies or randomized trials, the role of IM should be considered investigational in patients with bladder cancer.

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“…In patients undergoing RC with urinary diversion, the early NGT removal seems to influence positively the recovery of bowel function (Donat et al, 1999;Inman et al, 2003;Pruthi et al, 2003;Maffezzini et al, 2006Maffezzini et al, , 2007Maffezzini et al, , 2008De Vries et al, 2012;.…”

Section: Bowel Functionmentioning

confidence: 99%

“…Despite these findings, in clinical practice, there is still a wide range of opinions regarding post‐RC nutrition management. Moreover, some research studies provide contrasting results and findings one from another (Thurairaja et al ., ; Barrass et al ., ; Maffezzini et al ., ; Mathur et al ., ; Daneshmand et al ., ; Karl et al ., ; Baack Kukreja et al ., ; Declercq et al ., ).…”

Section: Introductionmentioning

confidence: 99%

The impact of oral nutrition in patients after radical cystectomy: an overview

Villa

Bresciani²,

Boarin³

et al. 2017

Int J of Uro Nursing

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Nutritional status is considered a significant factor determining the post‐operative outcomes after RC. The aim of this literature review is to describe the impact of early oral nutrition on functional outcomes in patients underwent cystectomy. Usually, these patients are not fed orally until the return of gastrointestinal function, because early oral nutrition is often perceived as detrimental for the anastomosis integrity and is believed to cause nausea and vomiting. This phase of nutritional deprivation may vary from a few days to a few weeks, depending on the return of bowel movements. In clinical practice, patients are fed on a substitutive nutritional support based on the use of total parenteral nutrition or enteral nutrition, which have not demonstrated positive effects on bowel function recovery time, infection complication rates or length of hospital stay. The early introduction of oral feeding seems to allow early mobilization and to lead to an improvement of post‐operative outcomes: bowel functions, pain, complications, patient's comfort and length of hospital stay. The early implementation of oral diet after cystectomy is associated with an improvement of considered outcomes, allowing an early recovery of patient's general conditions and reducing length of hospital stay.

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A Multimodal Perioperative Plan for Radical Cystectomy and Urinary Intestinal Diversion: Effects, Limits and Complications of Early Artificial Nutrition

Abstract: Early postoperative artificial nutrition did not affect the return of bowel function or postoperative protein depletion. Different strategies for more effective nutritional support will be explored in further studies.

Cited by 29 publications

References 17 publications

Effect of Preoperative Nutritional Deficiency on Mortality After Radical Cystectomy for Bladder Cancer

Effect of Preoperative Nutritional Deficiency on Mortality After Radical Cystectomy for Bladder Cancer

Malnourishment in bladder cancer and the role of immunonutrition at the time of cystectomy: an overview for urologists

The impact of oral nutrition in patients after radical cystectomy: an overview

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