MP65-16 ADMINISTRATION OF POSTOPERATIVE PARENTERAL NUTRITION DOES NOT AFFECT ONCOLOGICAL OUTCOMES AFTER RADICAL CYSTECTOMY (RC) IN BLADDER CANCER PATIENTS.

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive III1 Apr 2015MP65-16 ADMINISTRATION OF POSTOPERATIVE PARENTERAL NUTRITION DOES NOT AFFECT ONCOLOGICAL OUTCOMES AFTER RADICAL CYSTECTOMY (RC) IN BLADDER CANCER PATIENTS. Alvaro Vidal Faune, Bernhard Kiss, Fiona C. Burkhard, Urs E. Studer, George N. Thalmann, and Beat Roth Alvaro Vidal FauneAlvaro Vidal Faune More articles by this author , Bernhard KissBernhard Kiss More articles by this author , Fiona C. BurkhardFiona C. Burkhard More articles by this author , Urs E. StuderUrs E. Studer More articles by this author , George N. ThalmannGeorge N. Thalmann More articles by this author , and Beat RothBeat Roth More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2306AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Conflicting and inconclusive results exist whether total parenteral nutrition (TPN) stimulates cancer growth and causes tumor progression. In a prospective randomized trial we were able to show an increase in postoperative infectious complications in patients undergoing pelvic lymphadenectomy (PLND), RC, and urinary diversion if TPN was administered postoperatively, mainly because of an impairment of the immune system. However, there seems to be a clinical benefit of TPN for malnourished patients. The aim of this study was to assess whether administration of TPN influences oncological outcomes. METHODS From September 2008 to March 2011, 157 consecutive cystectomy patients (≤cT3, cN0, cM0) were prospectively randomized to receive either postoperative TPN (group A: n = 74) or oral nutrition alone (group B: n = 83). Postoperative follow-up (including computed tomography and bone scan 6, 12, and 24 mos following surgery) was performed after 3, 6, 12, 18 and 24 mos, and annually thereafter. Two patients did not have follow-up at our institution and were excluded, thus remaining 155 patients for analysis. RESULTS Median follow up was 49 mos (range: 1-81). Forty-two (57%) patients in group A and 45 (56%) patients in group B had organ confined disease (<pT3; p = 0.88). Local tumor recurrence (including pelvic lymph node metastases) was seen in 4 (5%) patients in group A and 4 (5%) patients in group B (p = 0.896). Twenty-three (31%) patients with TPN and 23 (28%) without TPN developed distant metastases (p = 0.715). During follow-up, 29 (39%) and 32 (39%) patients died in group A and B, respectively. 75% (22/29) of deaths in group A and 68% (22/32) in group B were cancer related. Median time to death was 19 mos in group A and and 20 mos in group B. Overall survival (OS; p=0.79) and cancer specific survival (CSS; p=0.95) did not differ between the two groups. Subgroup analysis showed a significant difference in OS (p = 0.026) and CSS (p = 0.048) in preoperatively 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 urinary diversion does not seem to impair long-term oncological outcomes. This is important in the context of malnourished cystectomy patients who seem to benefit from TPN in the early postoperative period, as previously shown. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e813 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alvaro Vidal Faune More articles by this author Bernhard Kiss More articles by this author Fiona C. Burkhard More articles by this author Urs E. Studer More articles by this author George N. Thalmann More articles by this author Beat Roth More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...