Perioperative nutrition for the treatment of bladder cancer by radical cystectomy

Abstract

Background Radical cystectomy (RC) is the primary surgical treatment for muscle-invasive urothelial carcinoma of the bladder. This major operation is typically associated with an extended hospital stay, a prolonged recovery period and potentially major complications. Nutritional interventions are beneficial in some people with other types of cancer and may be of value in this setting too. Objectives To assess the e ects of perioperative nutrition in people undergoing radical cystectomy for the treatment of bladder cancer. Search methods We performed a comprehensive search using multiple databases (Evidence Based Medicine Reviews, MEDLINE, Embase, AMED, CINAHL), trials registries, other sources of grey literature, and conference proceedings published up to 22 February 2019, with no restrictions on the language or status of publication. Selection criteria We included parallel-group randomised controlled trials (RCTs) of adults undergoing RC for bladder cancer. The intervention was any perioperative nutrition support. Data collection and analysis Two review authors independently assessed studies for inclusion, extracted data, and assessed risk of bias and the quality of evidence using GRADE. Primary outcomes were postoperative complications at 90 days and length of hospital stay. The secondary outcome was mortality up to 90 days a er surgery. When 90-day outcome data were not available, we reported 30-day data. Main results The search identified eight trials including 500 participants. Six trials were conducted in the USA and two in Europe. 1. Parenteral nutrition (PN) versus oral nutrition: based on one study with 157 participants, PN may increase postoperative complications within 30 days (risk ratio (RR) 1.40, 95% confidence interval (CI) 1.07 to 1.82; low-quality evidence). We downgraded the quality of evidence for serious study limitations (unclear risk of selection, performance and selective reporting bias) and serious Perioperative nutrition for the treatment of bladder cancer by radical cystectomy (Review)

Dramatic Impact of Centralization and a Multidisciplinary Bladder Cancer Program in Reducing Mortality: The CABEM Project

“…As previous epidemiologic studies have demonstrated, complications after cystectomy are associated with an increased risk of mortality. 33 - 35 In our series, mortality was significantly higher in group 1 versus 2 (34.5% v 5%, P = .0002).…”

“…Improving nutrition status with preoperative protein intake and nutritional therapy is related to a reduction in mortality. 33 Fast-track recovery protocols as the enhanced recovery after surgery have also been associated with lower length of hospital stay after RC. 31 In this study, we have observed similar findings.…”

Effect of Early Peripheral Parenteral Nutrition Support in an Enhanced Recovery Program for Colorectal Cancer Surgery: A Randomized Open Trial

“…However, these complications are not common (overall catheter-related infection occurred in 0-10.7% of patients receiving preoperative PN, pneumothorax in 0-6.7% of patients, phlebitis in 0-1.8%, air embolus 0-1.6%, and thrombosis 0-0.5%) and they were relatively easy to detect and to treat. Appropriate catheter care is a measure to prevent infectious complications [36].…”

<p>Optimal Delivery of Follow-Up Care After Radical Cystectomy for Bladder Cancer</p>

“…However, a Cochrane review exploring the evidence and quality of the studies found that the quality of evidence is low, and flagged the urgent need for high-quality research to better inform nutritional support interventions for people undergoing RC because of bladder cancer. 100 With regard to other important lifestyle factors such as smoking and risky drinking, which have a huge impact on physiological functions, there is generally strong evidence to support preoperative interventions to prevent postoperative complications if they are initiated 4-8 weeks before major surgery. There is still a lack of evidence to support short-term interventions, which is relevant to RC pathways, although studies have been performed, but are yet to be published.…”