Prognostic features for quality of life after radical cystectomy and orthotopic neobladder

Abstract

Purpose:To analyse prognostic features on quality of life (QoL) following radical cystectomy and urinary diversion via orthotopic neobladder in a single-centre patient cohort.Materials and Methods:Postoperative QoL of 152 patients was assessed retrospectively using the validated QLQ-C30 questionnaire. Potential associations of patient's quality of life including pre-and intraoperative characteristics, surgeon experience, postoperative time course, adjuvant therapies, and functional outcome were defined a priori and evaluated. Mann-Whitney-U-, Kruskal-Wallis-, Spearman correlation and post hoc-testing were used. A multivariate analysis using a multiple logistic regression model was performed. A p value <0.05 was considered to be statistically significant.Results:Median follow-up was 48 months. Univariate analysis of prognostic features for health-related QoL revealed a significant impact of gender (p=0.019), performance status (p<0.001), experience of surgeon (>100 previous cystectomies, p=0.007), and nerve-sparing surgery (p=0.001). Patients who underwent secondary chemotherapy or radiotherapy had significant lower QLQ-C30 scores (p=0.04, p=0.02 respectively). Patients who were asymptomatic had a significantly higher quality of life (p<0.001). A significant impact of severity of incontinence based on ICIQ-SF score (p<0.001) and daily pad usage (p<0.001), existence of daytime incontinence (p<0.001), existence of urgency symptoms (p=0.007), and IIEF-5 score (p<0.001) could be observed. In multivariate analysis, independent prognostic relevance could be confirmed for preoperative ECOG performance status of 0 (p=0.020 vs. ECOG 1, p=0.047 vs. ECOG 2), experience of the respective surgeon (≥100 vs. <100 previous cystectomies, p=0.021), and daytime continence (p=0.032).Conclusion:In the present study, we report health-related QoL outcomes in a contemporary patient cohort and confirm preoperative ECOG status, surgeon experience and daytime incontinence as independent prognostic features for a good postoperative QoL.

Mucosal Invasion, but Not Incomplete Excision, Has Negative Impact on Long-Term Survival in Patients With Extramammary Paget’s Disease

“…Formijne Jonkers et al (37) reported that 82% of patients who underwent creation of an intestinal stoma experienced one or more stomarelated complications within 1 year. Radical surgeries with creation of colostomy or urinary diversions deteriorate patients' organ functions, as well as patients' quality of life (33,(38)(39)(40). In our cohort, only three of 75 patients (4.0%) with boundary area involvement underwent colostomy or urinary diversion.…”

Patient-reported outcomes and health-related quality of life after urinary diversions

“…They also found that sexually active patients showed a significantly better QOL score compared with those being sexually inactive, also sexuality was the only independent factor related to QOL in the multivariate analysis [26]. Similarly Kretschmer et al [27] showed that a high erectile function score and nerve-sparing were associated with better QOL in patients with ONB after radical cystectomy.…”

Impact of Enhanced Recovery After Surgery on Long-Term Outcomes and Postoperative Recovery in Patients Undergoing Hepatectomy: A Retrospective Cohort Study

“…A current study which assessed postoperative quality of life of 152 patients with a median follow-up of 48 months revealed preoperative ECOG status, surgeon experience, and daytime incontinence as independent prognostic features of a good postoperative quality of life. 22 The impact of postoperative regimen on quality of life has not been examined so far. It is comprehensible that the postoperative management influences postoperative recovery in the short term and then influences long-term outcomes.…”