The impact of preoperative nutritional status on post-surgical complication and mortality rates in patients undergoing radical cystectomy for bladder cancer: a systematic review of the literature.

Abstract

To investigate the impact of preoperative nutritional factors [body mass index (BMI)], hypoalbuminemia (< 3.5g/dL, sarcopenia) on complication and mortality rates after radical cystectomy (RC) for bladder cancer. The PubMed database was systematically searched for studies investigating the effect of nutritional status on postoperative outcomes after RC. English-language articles published between March 2010 and March 2020 were reviewed. For statistical analyses odds ratios (ORs) and hazard ratios (HRs) weighted mean was applied. Overall, 81 studies were included. Twenty-nine studies were enrolled in the final analyses. Patients with a 25-29.9kg/m2 BMI (OR 1.55, 95% confidence interval [CI] 1.14-2.07) and those with a BMI ≥ 30kg/m2 (OR 1.73, 95% CI 1.29-2.40) had a significantly increased risk of 30day complications after RC. Preoperative hypoalbuminemia increased the risk of 30day complications (OR 1.56, 95% CI 1.07-2.35); it was a predictor of worse 3year overall survival (OS) (HR 1.86, 95% CI 1.32-2.66). Sarcopenic patients had a higher risk of 90day complications than non-sarcopenic ones (OR 2.49, 95% CI 1.22-5.04). Sarcopenia was significantly associated with unfavorable 5year cancer-specific survival (CSS) (HR 1.73, 95% CI 1.07-2.80), and OS (HR 1.60, 95% CI 1.13-2.25). High BMI, hypoalbuminemia, and sarcopenia significantly increased the complication rate after RC. Hypoalbuminemia predicted worse 3year OS and sarcopenia predicted unfavorable 5year CSS and OS. Preoperative assessment of RC patients' nutritional status is a useful tool to predict perioperative and survival outcomes.