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

Abstract

• 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.

Correlation between malnutrition, body mass index and complications in patients with urinary bladder cancer who underwent radical cystectomy

“…9 In a retrospective study of 905 patients, consisting of measuring BMI, weight loss and preoperative albumin level, "only preoperative albumin level was significantly associated with allcause mortality (…) within 90 days". 8 In our study, the BMI indicator itself was much more reliable. As we can see from the correspondence analysis and dendrogram, undernutrition and obesity are associated with higher rate in Clavien-Dindo scale.…”

“…In our study, more complications were found in the ND group, but no statistical relationship between those variables was noticed. 5,[8][9][10][11][12] It is possible that increasing the number of patients in the study group could lead us to different conclusions. We should remember that malnutrition, defined by the NRS scale, constitutes patients not only in an undernutrition state, but also patients at risk of malnutrition, i.e., the status in which patients are in an imbalance between the amount of absorbed and used substances.…”

Emerging Impact of Malnutrition on Surgical Patients: Literature Review and Potential Implications for Cystectomy in Bladder Cancer

“…However, many of these studies used low albumin as the definition for MN. 14 It is noteworthy that a recent MN consensus statement did not mandate laboratory tests such as albumin and prealbumin to diagnose MN because data suggest that these parameters do not respond to feeding interventions during an acute inflammatory response. 1 In a focused study with strict reporting guidelines that used a definition of NRS score 3 or greater the rate of MN was 55%.…”

Impact of immunonutrition on radical cystectomy immunoresponse and outcomes; opportunity for peri-operative optimization

“…In a recent review, postoperative immunonutrition in radical cystectomy was not associated with significant benefits outside of early return to a post-operative normal diet (12). Furthermore, since there is a paucity of data evaluating malnourished patients undergoing urological surgery in the nutritional supplement setting, there is no established consensus on the role of immunonutrition.…”