Nourishment for Bladder Cancer Surgery

Bladder cancer surgery patients with nutritional deficiencies had more complications

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Surgery can put the body under a great deal of stress. That’s why surgeons want their patients to be as healthy as possible before going under the knife. Recently, researchers found that being in good shape nutritionally is also important.

According to a new study, bladder cancer patients who had low albumin levels were twice as likely to have complications after surgery as patients with healthy levels.

Albumin levels signal how well the body absorbs protein.

The lead author of this study suggested that improving nutritional status before bladder cancer surgery could be an excellent way to improve surgical outcomes.

"Make sure you're getting enough protein."

David C. Johnson, MD, MPH, a third-year urology resident at University of North Carolina School of Medicine, and colleagues evaluated the role poor nutrition played in predicting complications within 30 days after surgery to remove the bladder.

The surgery is called a radical cystectomy and is performed when cancer has spread to the muscular wall of the bladder.

Alexander Kutikov, MD, associate professor of urologic surgical oncology at Fox Chase Cancer Center in Philadelphia, PA, told dailyRx News, "Cystectomy is an operation of great magnitude and its risks, especially for the elderly and the frail, are far from trivial."

While cystectomy is the standard of care for treating advanced bladder cancer, complications following the surgery are common and can include infections and problems with wound healing.

Dr. Johnson said in a prepared statement, "The prevalence of nutritional deficiency is very high in patients with bladder cancer, partly because of their disease and partly because of their advanced age — 73 years on average."

About 72,500 Americans will be diagnosed with bladder cancer this year.

The research team combed through the American College of Surgeons National Surgical Quality Improvement Program database to identify and analyze post-surgical complication data from 1,085 patients who had undergone a radical cystectomy between 2005 and 2011.

The researchers looked for three signs of poor nutrition in patients who were about to have the surgery — low albumin levels (less than 3 grams per deciliter), significant weight loss within six months of the operation and obesity (body mass index of 30 or more).

Body mass index, or BMI, is a measure of body composition. A BMI of 25 or more is considered overweight.

More than half (53 percent) of the bladder cancer patients had complications following surgery.

While all three nutritional deficiency factors were analyzed, only low albumin levels were a predictor of surgical complications.

The researchers found that patients who had low albumin before the surgery had 2.1 times greater risk of having complications following cystectomy than patients who had albumin levels in normal ranges or greater than 3 grams per deciliter.

"This work builds on growing evidence that nutritional status is an important predictor of outcomes for urologic and general oncological patients alike," said Dr. Kutikov, who was not involved in this study.

"Certainly nutritional deficiency may prove to be a useful selection criterion for less surgically aggressive bladder-sparing strategies," Dr. Kutikov said. "Furthermore, future work must focus on whether nutritional deficiency is a modifiable risk factor of poor prognosis. In other words, is this simply a marker of poor outcome or its reversible cause?" 

This study didn’t test whether correcting albumin levels prior to surgery would lower the risk of complications.

Still, Dr. Johnson recommended that patients with low albumin levels should visit a nutritionist before surgery to discuss possible dietary changes.

“There's very little risk in improving nutritional status before the operation and significant possible benefits," study co-author Angela Smith, MD, an assistant professor of urology at UNC, said in a statement.

Findings from this research were presented at the 2013 Clinical Congress of the American College of Surgeons.

All research is considered preliminary before being published in a peer-reviewed journal.

No funding or financial disclosure information was provided.

Review Date: 
October 7, 2013
Last Updated:
December 30, 2013