Perioperative nutrition for the treatment of bladder cancer by radical cystectomy.

Systematic review and meta-analysis of randomized trials in adults undergoing radical cystectomy for bladder cancer. The included studies were hospital-based trials from the USA and Europe, generally small and older, with mixed baseline nutritional status and incomplete reporting of age, sex, and other demographics.

Perioperative nutrition strategies varied across trials and included parenteral nutrition with dextrose and amino acids, branched-chain amino acid-containing IV solutions, preoperative oral nutritional supplements, immunonutrition drinks containing arginine and omega-3 fatty acids, and early postoperative feeding. Regimens ranged from 5 days preoperatively and 5 days postoperatively to 14 days postoperatively, and one oral supplement trial extended for 3 to 4 weeks before surgery and 4 weeks after surgery.

Overall, evidence for perioperative nutrition after radical cystectomy was limited and of low to very low certainty. Some regimens may help: immuno-enhancing nutrition may reduce 90-day complications, preoperative oral nutrition and amino acids with dextrose versus dextrose alone may reduce 30-day complications, and perioperative oral nutritional supplements may slightly decrease complications with little effect on length of stay. By contrast, parenteral nutrition compared with oral nutrition may increase complications (RR 1.40, 1.07 to 1.82), and early postoperative feeding showed little to no benefit and may increase complications (RR 1.14, 0.85 to 1.53).

The evidence base was small, heterogeneous, and largely composed of older trials with methodological limitations. Certainty was low or very low for most outcomes, with incomplete outcome reporting, wide confidence intervals, and variable intervention types, dosing, and comparators. Generalizability is limited because the trials were mostly single-center studies in hospital settings and several outcomes were not consistently reported.