Radical cystectomy (RC) for the management of muscle-invasive bladder cancer remains a morbid procedure with high rates of perioperative complications. The role of pre-operative immuno-nutritional supplementation (Pre-INS) in improving post-RC outcomes is promising and needs further validation.
We performed a retrospective review of 204 patients who underwent RC for bladder cancer at a single institution, comparing patients who received oral L-arginine-based Pre-INS, and those who did not. Pre-operative features, post-operative complications, and readmission data were collected. Outcomes of interest included development of high-grade (Clavien-Dindo III-V) complications, readmission within 30 days, ileus, total parenteral nutrition (TPN) requirement, post-operative infection, and length of stay (LOS). Categorical and continuous outcomes were assessed using Fisher's exact test and Welch T-test, respectively. Multivariable logistic regression (MLoR) analysis was used to identify predictive factors for our outcomes.
Patients who received Pre-INS had significantly lower odds of requiring post-operative TPN (17.3% vs 35.6%; Fisher p=0.015, OR=0.38), and developing post-operative infection (25% vs 45%; Fisher p=0.003; OR=0.41), but no significant difference in the rates of other outcomes. On MLoR, when adjusting for age, gender, BMI, Charlson Comorbidity Index, undergoing neoadjuvant chemotherapy, and operative features, Pre-INS was a significant predictor of post-operative infection (Fisher p=0.02; OR=0.35), but not for high-grade complications, readmission, ileus, needing TPN, or LOS.
Pre-operative immunonutrition with an L-arginine-based supplement is associated with significant reduction in post-operative infection, one of the most common complications of RC.
The Journal of urology. 2021 Jun 29 [Epub ahead of print]
Sari Khaleel, Subodh Regmi, Peter Hannah, Bradly Watarai, Niranjan Sathianathen, Christopher Weight, Badrinath Konety
Department of Urology, University of Minnesota, Minneapolis, Minnesota., Peter MacCallum Cancer Centre, Melbourne, Australia., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio., Rush Medical College, Chicago, Illinois.