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515 Does postoperative parenteral nutrition after radical cystectomy impact oncological and functional outcomes in bladder cancer patients?
515
Does postoperative parenteral nutrition after radical cystectomy impact oncological and functional outcomes in bladder cancer patients? Eur Urol Suppl 2016;15(3);e515
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Vidal Faune A., Arnold N., Vartolomei M., Kiss B., Burkhard F.C., Thalmann G.N., Roth B. University Hospital Berne, Dept. of Urology, Berne, Switzerland INTRODUCTION & OBJECTIVES: To evaluate the long-term oncological and functional outcomes of postoperative Total Parenteral Nutrition (TPN) after Radical Cystectomy (RC), extended Pelvic Lymph Node Dissection (ePLND), and ileal Urinary Diversion (UD). MATERIAL & METHODS: A randomised single-centre, single-blinded, two-arm trial was conducted on 157 consecutive patients (≤cT3, cN0, cM0) who underwent RC, ePLND, and ileal UD. From September 2008 to March 2011. Patients were randomized to receive either postoperative TPN (group A: n = 74) or oral nutrition alone (group B: n = 83). Regular postoperative follow-up was performed at our outpatient clinic. The median follow-up was 49 (1-81) months. Two patients in group B did not have follow-up at our institution and thus were excluded. Validated questionnaires were used to evaluate bowel function, sexual function, and quality of life. Neobladder function was evaluated using an institutional questionnaire. Local recurrences and distal metastases were assessed using computed tomography and bone scan at regular follow-up visits. RESULTS: There was no significant difference between the two groups in terms of the rate of local (pelvic) recurrence (4/74 [5.4%] in group A; 4/81 [4.9%] in group B; p = 0.9), the rate of distant metastases (23/74 [31%] in group A; 23/81 [30%] in group B; p = 0.7), cancer-specific survival (p = 0.9) or overall survival (p = 0.8). Group B had significantly better bowel function at 3 (p = 0.03) and 12 (p = 0.01) months. There was no difference between the two groups in terms of quality of life, sexual and neobladder function. Subgroup analysis showed a significant difference in OS (p = 0.026) and CSS (p = 0.048) in pre operatively malnourished patients (n = 34); however, there was no difference in OS (p = 0.914) and CSS (p = 0.693) between group A and B malnourished patients. CONCLUSIONS: The negative influence on the immune system seen in bladder cancer patients after the administration of TPN following PLND, RC, and UD does not seem to impair long-term oncological outcomes. However, TPN negatively influences long-term bowel function and should therefore be given in a highly selected cohort of patients only.
Does postoperative parenteral nutrition after radical cystectomy impact oncological and functional outcomes in bladder cancer patients? Eur Urol Suppl 2016;15(3);e515
Print! Print!
Vidal Faune A., Arnold N., Vartolomei M., Kiss B., Burkhard F.C., Thalmann G.N., Roth B. University Hospital Berne, Dept. of Urology, Berne, Switzerland INTRODUCTION & OBJECTIVES: To evaluate the long-term oncological and functional outcomes of postoperative Total Parenteral Nutrition (TPN) after Radical Cystectomy (RC), extended Pelvic Lymph Node Dissection (ePLND), and ileal Urinary Diversion (UD). MATERIAL & METHODS: A randomised single-centre, single-blinded, two-arm trial was conducted on 157 consecutive patients (≤cT3, cN0, cM0) who underwent RC, ePLND, and ileal UD. From September 2008 to March 2011. Patients were randomized to receive either postoperative TPN (group A: n = 74) or oral nutrition alone (group B: n = 83). Regular postoperative follow-up was performed at our outpatient clinic. The median follow-up was 49 (1-81) months. Two patients in group B did not have follow-up at our institution and thus were excluded. Validated questionnaires were used to evaluate bowel function, sexual function, and quality of life. Neobladder function was evaluated using an institutional questionnaire. Local recurrences and distal metastases were assessed using computed tomography and bone scan at regular follow-up visits. RESULTS: There was no significant difference between the two groups in terms of the rate of local (pelvic) recurrence (4/74 [5.4%] in group A; 4/81 [4.9%] in group B; p = 0.9), the rate of distant metastases (23/74 [31%] in group A; 23/81 [30%] in group B; p = 0.7), cancer-specific survival (p = 0.9) or overall survival (p = 0.8). Group B had significantly better bowel function at 3 (p = 0.03) and 12 (p = 0.01) months. There was no difference between the two groups in terms of quality of life, sexual and neobladder function. Subgroup analysis showed a significant difference in OS (p = 0.026) and CSS (p = 0.048) in pre operatively malnourished patients (n = 34); however, there was no difference in OS (p = 0.914) and CSS (p = 0.693) between group A and B malnourished patients. CONCLUSIONS: The negative influence on the immune system seen in bladder cancer patients after the administration of TPN following PLND, RC, and UD does not seem to impair long-term oncological outcomes. However, TPN negatively influences long-term bowel function and should therefore be given in a highly selected cohort of patients only.