Influence of perioperative nutritional support on recovery and complications following radical cystectomy and urinary diversion

Abstract

Radical cystectomy (RC) with pelvic lymph node dissection (PLND) and urinary diversion is the preferred treatment for T2-T4a N0M0 muscle-invasive bladder cancer, BCG-refractory, very-high-risk non-muscle-invasive bladder cancer (NMIBC), BCG-relapsing, and BCG-unresponsive NMIBC, and bacillus of Calmette-Guérin (BCG)-responsive NMIBC. Nevertheless, this procedure continues to be categorized by a high incidence of perioperative complications, regardless of whether it is performed using a laparotomic or minimally invasive approach. Overall complications are encountered by up to 64% of RC patients. The preoperative nutritional status of patients is one of the emerging factors that may influence their rehabilitation after this surgery. Patients who are at malnutrition risk are more susceptible to post-surgical complications following major urological surgery. Additionally, adverse overall survival and ninty-day mortality are significantly predicted by nutritional status prior to RC, which is determined by evaluation of preoperative body mass index, serum albumin, and weight loss. To enhance perioperative care, pathways OF enhanced recovery after surgery (ERAS) have been implemented in the field of urology. Specialized immunonutrition (SIM) beverages, which are intended to enhance the immune function of patients, are included in these protocols and have been shown to decrease complications following RC, particularly infections. SIM beverages are composed of standard nutrition preparations that have been supplemented with specific nutrients, involving arginine, omega-3 fatty acids, and glutamine. Even though SIM has been demonstrated to enhance the host immune response, modulate inflammatory response, and enhance protein synthesis following surgery, its function through ERAS pathway following RC remainders uncertain. This review article aims to highlight effect of perioperative nutritional optimization on post operative complications incidence, particularly wound related complications in cases had RC and ileal conduit urinary diversion.