Influence of Body Mass Index on Operability, Morbidity and Disease Outcome following Radical Cystectomy

Abstract

Introduction: Obesity may influence postoperative outcome after tumor surgery. We evaluated the impact of patients’ body mass index (BMI) on peri- and postoperative morbidity and outcome following radical cystectomy for bladder cancer. Patients and Methods: 390 consecutive patients who underwent radical cystectomy due to bladder cancer from January 1986 to December 2004 were reviewed. According to WHO criteria, patients were divided into normal weight (NW, 45.6%), overweight (OW, 44.4%) and obese (10.0%) subgroups. The BMI of patients was associated to the time of surgery, amount of intraoperative blood units, TNM stage, postoperative complication rate as well as overall survival. Results: The time of cystectomy increased with the degree of patients’ obesity (NW, 330 min; OW, 355 min; p = 0.007). Between NW and OW patients no significant differences were noted in respect to intraoperative blood transfusion rate (NW, 3.0; OW, 2.0; p = 0.47), postoperative TNM stage (pTis–pT2b: 42.6 vs. 48.6%; pT3a–4: 38.2 vs. 27.2%; pN+: 20.2 vs. 24.2%) and postoperative complications, except for postoperative bleeding, which was more common in OW patients (p = 0.02). Mean overall survival times showed no significant differences between NW and OW patients receiving ileal conduits (5-year survival rate: 34.0 vs. 41.1%; p = 0.140) or ileal neobladders (5-year survival rate: 65.1 vs. 70.8%; p = 0.127). Conclusions: Increased BMI poses a greater challenge for surgical interventions such as radical cystectomy in bladder cancer patients. However, in our series, intra- and postoperative morbidity was not significantly elevated in OW patients. Overall survival was not reduced in OW compared to NW patients. Therefore, elevated BMI is not an exclusion criterion for radical cystectomy in bladder cancer patients.

Obesity and prognosis in muscle‐invasive bladder cancer: The continuing controversy

“…13 However, other studies did not find a correlation between obesity and bladder cancer. 9,12 In the present study, overweight and obese patients who underwent radical cystectomy for MIBC had more favorable pathological features and a better prognosis than those with normal BMI values. Furthermore, the results of multivariable analysis showed that a low BMI is a significant factor of poor prognosis compared with other clinicopathological factors.…”

“…9 For example, increased BMI is associated with increased operative times, blood loss and perioperative complications compared with those in patients with normal weight. 10 However, in the present study, we found no differences in the 90-day mortality rate according to BMI category, which showed that obesity had no effect on the incidence of perioperative complications.…”

“…8 Several investigators have reported that obesity is independently associated with a higher risk of perioperative complications after radical cystectomy, and can lead to increased technical challenges during the procedure. 9,10 By contrast, preoperative nutritional deficiency is a risk factor for increased mortality and poor overall survival after radical cystectomy for bladder cancer. 11 Furthermore, the relationship between BMI and oncological outcomes in patients undergoing radical cystectomy for bladder cancer remains under debate.…”

Preoperative nutritional factors and outcomes after radical cystectomy: A narrative review

“…Reyes et al 33 found that tract infections, pyelonephritis, wound infections and overall complications were less frequent in normal-weight patients (18.5-24.9kg/m 2 ) compared to overweight (25-29.9kg/m 2 ) and obese (≥30.0kg/m 2 ) patients. BMI was not a predictor of mortality and complication development after RC in the Maurer et al 35 study, except for postoperative bleeding, which was more frequent in subjects with a high BMI. Compared to subjects with a BMI of 18-25kg/m 2 , subjects with a BMI >30kg/m 2 had a higher risk of cancer-specific mortality 38,42 , incisional hernia 40 , re-admission 30d and 90d after RC 39 , ileus 36 , parastomal hernia 45 and deep venous thrombosis 43,44 .…”

“…Twelve studies investigated the association between BMI and RC outcomes [33][34][35][36][37][38][39][40][41][42][43][44] . Reyes et al 33 found that tract infections, pyelonephritis, wound infections and overall complications were less frequent in normal-weight patients (18.5-24.9kg/m 2 ) compared to overweight (25-29.9kg/m 2 ) and obese (≥30.0kg/m 2 ) patients.…”