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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. World J Urol 2020; 39:1045-1081. [PMID: 32519225 DOI: 10.1007/s00345-020-03291-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/29/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To investigate the impact of preoperative nutritional factors [body mass index (BMI)], hypoalbuminemia (< 3.5 g/dL, sarcopenia) on complication and mortality rates after radical cystectomy (RC) for bladder cancer. METHODS 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. RESULTS Overall, 81 studies were included. Twenty-nine studies were enrolled in the final analyses. Patients with a 25-29.9 kg/m2 BMI (OR 1.55, 95% confidence interval [CI] 1.14-2.07) and those with a BMI ≥ 30 kg/m2 (OR 1.73, 95% CI 1.29-2.40) had a significantly increased risk of 30 day complications after RC. Preoperative hypoalbuminemia increased the risk of 30 day complications (OR 1.56, 95% CI 1.07-2.35); it was a predictor of worse 3 year overall survival (OS) (HR 1.86, 95% CI 1.32-2.66). Sarcopenic patients had a higher risk of 90 day complications than non-sarcopenic ones (OR 2.49, 95% CI 1.22-5.04). Sarcopenia was significantly associated with unfavorable 5 year cancer-specific survival (CSS) (HR 1.73, 95% CI 1.07-2.80), and OS (HR 1.60, 95% CI 1.13-2.25). CONCLUSION High BMI, hypoalbuminemia, and sarcopenia significantly increased the complication rate after RC. Hypoalbuminemia predicted worse 3 year OS and sarcopenia predicted unfavorable 5 year CSS and OS. Preoperative assessment of RC patients' nutritional status is a useful tool to predict perioperative and survival outcomes.
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Michalski W, Poniatowska G, Jonska-Gmyrek J, Kucharz J, Stelmasiak P, Nietupski K, Ossolinska-Skurczynska K, Sobieszczuk M, Demkow T, Wiechno P. Venous thromboprophylaxis in urological cancer surgery. Med Oncol 2019; 37:11. [PMID: 31768889 DOI: 10.1007/s12032-019-1331-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/11/2019] [Indexed: 11/26/2022]
Abstract
Venous thromboembolism (VTE) represents a major complication of cancer and its treatment, contributing to increased morbidity and mortality. The appropriate choice of thromboprophylaxis method and duration is, therefore, of utmost importance. We conducted an extensive review of the literature concerning VTE in patients undergoing surgery for urological cancers. Special attention was paid to risk factors, different types of surgery (transurethral, pelvic, abdominal-open, laparoscopic and robot-assisted) and different medications used (heparins, vitamin K antagonists and new oral anticoagulants). Original papers, reviews and guidelines were identified in Medline database. The available data were then summarised for the purpose of this article. Venous thromboprophylaxis is obligatory in urological cancer patients undergoing surgical treatment. Unless individual contraindications are recognised, the available guidelines should be followed. The variety of clinical scenarios and patients' comorbidities necessitate cooperation with other specialists (cardiologists, neurologists, etc.) in choosing the optimal management. Thrombosis risk must be carefully weighed against bleeding risk.
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Affiliation(s)
- Wojciech Michalski
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Grazyna Poniatowska
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Joanna Jonska-Gmyrek
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Jakub Kucharz
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland.
| | - Pawel Stelmasiak
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Karol Nietupski
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Katarzyna Ossolinska-Skurczynska
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Michal Sobieszczuk
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Tomasz Demkow
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Pawel Wiechno
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
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Naik R, Mandal I, Hampson A, Lane T, Adshead J, Rai BP, Vasdev N. The role of extended venous thromboembolism prophylaxis for major urological cancer operations. BJU Int 2019; 124:935-944. [PMID: 31468645 DOI: 10.1111/bju.14906] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Venous thromboembolism (VTE), consisting of both pulmonary embolism (PE) and deep vein thromboses (DVT), remains a well-recognised complication of major urological cancer surgery. Several international guidelines recommend extended thromboprophylaxis (ETP) with LMWH, whereby the period of delivery is extended to the post-discharge period, where the majority of VTE occurs. In this literature review we investigate whether ETP should be indicated for all patients undergoing major urological cancer surgery, as well procedure specific data that may influence a clinician's decision. METHODS We performed a search of six databases (PubMed, Cochrane, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and British Nursing Index (BNI)) from inception to June 2019, for studies looking at adult patients who received VTE prophylaxis after surgery for a major urological malignancy. RESULTS Eighteen studies were analysed. VTE risk is highest in open and robotic Radical Cystectomy (RC) (2.6-11.6%) and ETP demonstrates a significant reduction in risk of VTE, but not a significant difference in Pulmonary Embolism (PE) or mortality. Risk of VTE in open Radical Prostatectomy (RP) (0.8-15.7%) is comparable to RC, but robotic RP (0.2-0.9%), open partial/radical nephrectomy (1.0-4.4%) and robotic partial/radical nephrectomy (0.7-3.9%) were lower risk. It has not been shown that ETP reduces VTE risk specifically for RP or nephrectomy. CONCLUSION The decision to use ETP is a fine balance between variables such as VTE incidence, bleeding risk and perioperative morbidity/mortality. This balance should be assessed for each specific procedure type. While ETP still remains of net benefit for open RP as well as open and robotic RC, the balance is closer for minimally invasive RP as well as radical and partial nephrectomy. Due to a lack of procedure specific evidence for the use of ETP, adherence with national guidelines remains poor. Therefore, we advocate further studies directly comparing ETP vs standard prophylaxis, for specific procedure types, in order to allow clinicians to make a more informed decision in future.
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Affiliation(s)
- Rishi Naik
- Faculty of Medical Sciences, UCL Medical School, University College London, London, UK
| | - Indrajeet Mandal
- Faculty of Medical Sciences, UCL Medical School, University College London, London, UK
| | | | - Tim Lane
- Department of Urology, Lister Hospital, Stevenage, UK
| | - Jim Adshead
- Department of Urology, Lister Hospital, Stevenage, UK
| | | | - Nikhil Vasdev
- Department of Urology, Lister Hospital, Stevenage, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Schomburg JL, Krishna S, Cotter KJ, Soubra A, Rao A, Konety BR. Preoperative Incidence of Deep Venous Thrombosis in Patients With Bladder Cancer Undergoing Radical Cystectomy. Urology 2018; 116:120-124. [DOI: 10.1016/j.urology.2018.01.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/03/2018] [Accepted: 01/06/2018] [Indexed: 12/12/2022]
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Schomburg J, Krishna S, Soubra A, Cotter K, Fan Y, Brown G, Konety B. Extended outpatient chemoprophylaxis reduces venous thromboembolism after radical cystectomy. Urol Oncol 2018; 36:77.e9-77.e13. [DOI: 10.1016/j.urolonc.2017.09.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/04/2017] [Accepted: 09/29/2017] [Indexed: 11/30/2022]
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Allaire J, Ben-Zvi T, Lamarche B, Robitaille K, Fradet Y, Lacombe L, Fradet V. Preoperative nutritional factors and outcomes after radical cystectomy: A narrative review. Can Urol Assoc J 2017; 11:419-424. [PMID: 29106362 DOI: 10.5489/cuaj.4471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Only a few nutritional factors have been identified to predict the risk of developing complications after radical cystectomy (RC). This narrative review delineates the current known effects of preoperative nutritional status factors in this context. The report highlights the heterogeneity between study methods and results. We determined that low albuminemia values increase mortality risk and overall complications. In addition, obesity tends to increase the risk of developing venous thromboembolism and adverse events. Additional prospective studies, using standardized methods to both define and report complications, should be conducted to strengthen the connections between preoperative nutritional status factors and post-RC complications. Furthermore, intervention studies testing the impact of strategies to improve nutritional status on the risk of complications after RC are also needed.
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Affiliation(s)
- Janie Allaire
- Department of Surgery, Université Laval; Quebec, QC, Canada.,Centre de recherche du CHU de Québec - Université Laval, L'Hôtel Dieu de Québec; Quebec, QC, Canada.,Institute of Nutrition and Functional Foods, Université Laval; Quebec, QC, Canada
| | - Tal Ben-Zvi
- Department of Surgery, Université Laval; Quebec, QC, Canada.,Centre de recherche du CHU de Québec - Université Laval, L'Hôtel Dieu de Québec; Quebec, QC, Canada
| | - Benoît Lamarche
- Institute of Nutrition and Functional Foods, Université Laval; Quebec, QC, Canada
| | - Karine Robitaille
- Centre de recherche du CHU de Québec - Université Laval, L'Hôtel Dieu de Québec; Quebec, QC, Canada
| | - Yves Fradet
- Department of Surgery, Université Laval; Quebec, QC, Canada.,Centre de recherche du CHU de Québec - Université Laval, L'Hôtel Dieu de Québec; Quebec, QC, Canada
| | - Louis Lacombe
- Department of Surgery, Université Laval; Quebec, QC, Canada.,Centre de recherche du CHU de Québec - Université Laval, L'Hôtel Dieu de Québec; Quebec, QC, Canada
| | - Vincent Fradet
- Department of Surgery, Université Laval; Quebec, QC, Canada.,Centre de recherche du CHU de Québec - Université Laval, L'Hôtel Dieu de Québec; Quebec, QC, Canada.,Institute of Nutrition and Functional Foods, Université Laval; Quebec, QC, Canada
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Faut M, Heidema RM, Hoekstra HJ, van Ginkel RJ, Been SLB, Kruijff S, van Leeuwen BL. Morbidity After Inguinal Lymph Node Dissections: It Is Time for a Change. Ann Surg Oncol 2016; 24:330-339. [PMID: 27519351 PMCID: PMC5215190 DOI: 10.1245/s10434-016-5461-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Inguinal lymph node dissection (ILND) for stage 3 melanoma is accompanied by high wound complication rates. During the past decades, several changes in perioperative care have been instituted to decrease the incidence of these complications. This study aimed to evaluate the effect of these different care protocols on wound complications after ILND. METHODS A retrospective analysis of prospectively collected data was performed with 240 patients who underwent an ILND in the University Medical Center Groningen between 1989 and 2014. Four groups with different treatment protocols were analyzed: A (≥10 days of bed rest with a Bohler Braun splint), B (10 days of bed rest without a splint), C (5 days of bed rest), and D (1 day of bed rest). The effect of early mobilization, abolishment of the Bohler Braun splint and postural restrictions, and the introduction of prophylactic antibiotics were analyzed. RESULTS One or more wound complications occurred in 51.2 % of the patients including wound infection (29.8 %), seroma (21.5 %), wound necrosis (13.6 %), and hematoma (5 %). In consecutive periods, respectively 44.4, 60.3, 44.9 and 55.2 % of the patients experienced wound complications. None of the instituted changes in protocols led to a decrease in wound complications. CONCLUSION Changes in perioperative care protocols did not affect the rate of wound complications. Perhaps a change in the surgical procedure itself can lead to the necessary reduction of wound complications after ILND.
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Affiliation(s)
- Marloes Faut
- Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Rianne M Heidema
- Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Harald J Hoekstra
- Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Robert J van Ginkel
- Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - S Lukas B Been
- Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Schelto Kruijff
- Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
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