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

Allaire, Janie; Ben-Zvi, Tal; Lamarche, Benoı̂t; Robitaille, Karine; Fradet, Yves; Lacombe, Louis; Fradet, Vincent

doi:10.5489/cuaj.4471

Cited by 6 publications

(9 citation statements)

References 54 publications

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“…The SNAP factors often co-exist and each add to the surgical risk [13][14][15]: about 50% for daily smoking, alcohol > 2 drinks/day [16] and severe malnutritionsimilar to the risks related to severe cardiac, pulmonary and kidney insufficiency. Obesity even at cancer surgery [17][18][19] and low physical activity are followed by 10-20% increase [20]. Frailty is an example of co-existing SNAP factors with a major impact on the surgical outcome [21,22].…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

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STRONG for Surgery & Strong for Life — against all odds: intensive prehabilitation including smoking, nutrition, alcohol and physical activity for risk reduction in cancer surgery — a protocol for an RCT with nested interview study (STRONG-Cancer)

Tønnesen

Lydom

Joensen

et al. 2022

Trials

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Background There is a large unused potential for risk reduction in the preoperative period via effective lifestyle intervention targeting co-existing risky lifestyles: Smoking, malNutrition, obesity, risky Alcohol intake and insufficient Physical activity (SNAP). This trial compares the efficacy of the integrated STRONG programme with standard care on preoperative risk reduction and secondly on SNAP factor improvement and frailty, postoperative complications and quality of life. A nested interview study explores the patient preferences and the multi-perspective view of patients, relatives and health professionals. Methods In total, 42 surgical patients with ≥1 SNAP factor are allocated to individually tailored STRONG programme or usual care during adjuvant chemotherapy prior to radical bladder cancer surgery. The STRONG programme has ≥6 weekly sessions with patient education, motivational and pharmaceutical support. It is based on intensive smoking and alcohol cessation interventions reporting perioperative quit rates > 50%. Surgical risk reduction is measured as ≥1 step for 1 or more risky lifestyles on the ASA-score, secondly as having no risky SNAP factors, and as any SNAP improvement. The outcomes are validated by measurements and biomarkers. Postoperative complications are categorised according to the Clavien-Dindo classification. Health-related quality of life is measured by EQ-5D. The patients are followed up after 6 weeks at surgery and 6 weeks and 6 months postoperatively. A representative sample of the participants, their relatives and the clinical staff are interviewed until data saturation. Transcription, triangulated analyses and data management are conducted using NVivo computer software. Discussion The surgical agenda is characterised by fixed dates for surgery focusing on clear risk reduction within a short time. This requires a clinical useful lifestyle intervention programme with a high effect and coverage as well as containing all SNAP factors and tailored to individual needs. The STRONG programme seems to meet these requirements. After development in multi-professional collaboration, STRONG is delivered by a specially trained nurse as part of the surgical patient journey. Overall, this study will bring important new knowledge about risk reduction in a frail patient group undergoing major cancer surgery. Trial registration Registration at www.clintrials.gov (NCT04088968) The manuscript form from https://trialsjournal.biomedcentral.com/bmc/journal and the SPIRIT guidelines are followed.

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Section: Background and Rationale {6a}mentioning

confidence: 99%

“…General physical exercise reduces the postoperative recovery, but the impact on complications is disappointing [20,33,34]. Preoperative obesity and frailty interventions are still sparsely investigated in cancer surgery [18,[35][36][37].…”

Section: Need For a Combined Programmementioning

confidence: 99%

STRONG for Surgery & Strong for Life — against all odds: intensive prehabilitation including smoking, nutrition, alcohol and physical activity for risk reduction in cancer surgery — a protocol for an RCT with nested interview study (STRONG-Cancer)

Tønnesen

Lydom

Joensen

et al. 2022

Trials

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“…The primary exposure was pre-operative BMI, categorically operationalized in four strata according to the World Health Organization criteria: <18. 5…”

Section: Exposurementioning

confidence: 99%

“…1,3,4 Data regarding the effect of BMI on peri-operative complications are sparse with some evidence that patients with a low BMI have increased risk peri-operative complications, possibly relating to disease severity or poor nutrition. 5 Due to the conflicting data currently available, we sought to assess the association between patient BMI and morbidity and mortality associated with radical cystectomy. To do so, we utilized the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database, a large, multi-institutional, validated registry that has been shown to perform better than administrative databases or institutional series in capturing intra-operative and post-operative complications.…”

Section: Introductionmentioning

confidence: 99%

The association between patient body mass index and perioperative outcomes following radical cystectomy: An analysis using the American College of Surgeons National Surgical Quality Improvement Program database

Lenardis

Harper

Satkunasivam³

et al. 2019

CUAJ

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Introduction: Radical cystectomy is a highly morbid procedure with 30-day perioperative complication rates approaching 50%. Our objective was to determine the effect of patients’ body mass index (BMI) on perioperative outcomes following radical cystectomy for bladder cancer. Methods: We identified 3930 eligible patients who underwent radical cystectomy for nonmetastatic bladder cancer using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. The primary exposure was preoperative BMI, categorically operationalized in four strata according to the World Health Organization criteria: <18.5 kg/m2, 18.5–25 kg/m2, 25–30 kg/m2, and >30 kg/m2. Our primary outcome was major perioperative complication comprising mortality, reoperation, cardiac event, or neurological event. Results: BMI was significantly associated with rates of major complications (p=0.003): major complications were experienced by 17.0% of patients with BMI <18.5 kg/m2, 7.8% of patients with BMI 18.5–25 kg/m2, 7.9% of patients with BMI 25–30 kg/m2, and 10.8% of patient with BMI >30 kg/m2. Following multivariable adjustment for relevant demographic, comorbidity, and treatment factors, compared to patients with BMI 18.5–25 kg/m2, patients with BMI <18.5 kg/m2 (odds ratio [OR] 2.28; 95% confidence interval [CI] 1.07–4.78) and BMI >30 kg/m2 (OR 1.59; 95% CI 1.17–2.16) were significantly more likely to experience a major complication in the 30 days following cystectomy. Among the secondary outcomes, significant differences were identified in rates of pulmonary complications (p=0.003), infectious complications (p<0.001), bleeding requiring transfusion (p=0.01), and length of stay (p=0.001). Conclusions: Patients who are outside of a normal BMI range are more likely to experience major complications following radical cystectomy for bladder cancer.

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“…Furthermore, the association between malnutrition and poor surgical outcomes is well known. Several studies have shown that the presence of malnutrition biomarkers (e.g., low albumin, BMI, weight loss) increases the likelihood of post-RC complications [14][15][16][17]. In addition, severe wasting of skeletal muscle (sarcopenia) is predictive of oncologic and functional outcomes after RC [4,8,18,19].…”

Section: Introductionmentioning

confidence: 99%

Nutritional Status Impairment Due to Neoadjuvant Chemotherapy Predicts Post-Radical Cystectomy Complications

et al. 2021

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Background: Radical cystectomy (RC) is the standard treatment for muscle invasive bladder cancer (MIBC). Neoadjuvant chemotherapy (NAC) is associated with improved patient survival. The impact of NAC on nutritional status is understudied, while the association between malnutrition and poor surgical outcomes is well known. This study aims to examine the association between NAC, nutritional status impairment, and post-operative morbidity. Materials and Methods: We included MIBC patients who underwent RC and received NAC from multiple academic centers in Israel. Cross-sectional imaging was used to measure the psoas muscle area and normalized it by height (smooth muscle index, SMI). Pre- and post-NAC SMI difference was calculated (represents nutritional status change). The primary outcomes were post-RC ileus, infection, and a composite outcome of any complication. Logistic regression models were fit to identify independent predictors of the outcomes. Results: Ninety-one patients were included in the study. The median SMI change was −0.71 (−1.58, −0.06) cm2/m2. SMI decline was significantly higher in patients with post-RC complications (−18 vs. −203, p < 0.001). SMI change was an independent predictor of all complications, ileus, infection, and other complications. The accuracy of SMI change for predicting all complications, ileus, infection, and other complications was 0.85, 0.87, 0.75, and 0.86, respectively. Conclusions: NAC-related nutritional deterioration is associated with increased risk of complications after RC. Our results hint towards the need for nutritional intervention during NAC prior to RC.

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

Cited by 6 publications

References 54 publications

STRONG for Surgery & Strong for Life — against all odds: intensive prehabilitation including smoking, nutrition, alcohol and physical activity for risk reduction in cancer surgery — a protocol for an RCT with nested interview study (STRONG-Cancer)

STRONG for Surgery & Strong for Life — against all odds: intensive prehabilitation including smoking, nutrition, alcohol and physical activity for risk reduction in cancer surgery — a protocol for an RCT with nested interview study (STRONG-Cancer)

The association between patient body mass index and perioperative outcomes following radical cystectomy: An analysis using the American College of Surgeons National Surgical Quality Improvement Program database

Nutritional Status Impairment Due to Neoadjuvant Chemotherapy Predicts Post-Radical Cystectomy Complications

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