ASCO GU 2017: Optimizing Outcomes in Muscle-Invasive and Metastatic Bladder Cancer - Urologist View - Session Highlights
Orlando, Florida USA (UroToday.com) Eugene Lee, University of Kansas, discussed preoperative risk stratification. These include comorbidity indices with limitations including subjective nature and not uniform. The ‘eyeball’ test includes patient age, wheelchair sign, posture, skin/turgor and gait. Measuring body composition using the skeletal muscle index derived from preoperative CT imaging is a useful index with sarcopenia associated with survival outcomes. Then how can we improve a ‘pre-rehabilitation’ program? Radical cystectomy has up to 60% complication rate with significant infection and gastrointestinal complications. Early recovery pathways, alvimopan and immunonutrition are some measures to promote early recovery. Malnutrition defined albumin <3.5 gm/dl and BMI <18.5 kg/mi2 is significantly associated with morbidity and mortality. Immunonutrition may play an important role in this patient population with preliminary data supporting the use of this in patients undergoing radical cystectomy. Myeloid-derived suppressor cells are important in the inflammatory process with significantly decreased MDSCs associated with immunonutrition.
Presenter: Eugene Lee, University of Kansas
Written By: Stephen B. Williams, MD, Assistant Professor, The University of Texas Medical Branch at Galveston, Galveston, TX and Ashish M. Kamat, MD, Professor, The University of Texas MD Anderson, Houston, TX