Impact of Minimally Invasive Approach to Radical Cystectomy in Bladder Cancer Patients with Malnutrition

Malnutrition is associated with higher rates of complications following radical cystectomy (RC) for the treatment of muscle-invasive bladder cancer. The newer robotic approach to RC has yet to be analyzed against the open approach in malnourished patients with respect to perioperative complications. A retrospective cohort analysis of RC patients with a postoperative diagnosis of bladder cancer and non-disseminated disease was performed. Malnourishment was defined as either low serum albumin (<3.5 g/dL), >10% 6-month preoperative weight loss, or BMI <18.5 kg/m(2)). Multivariable and generalized logistic regression were used for categorical and continuous outcomes respectively. Malnourishment was associated with greater systemic sepsis, bleeding transfusions, 30-day mortality, postoperative C. difficile infection, and days from operation to discharge (DOD) (all P < 0.05). In malnourished patients, robotic approach was associated with lower adjusted odds of bleeding transfusions (aOR = 0.51, P < 0.05) and fewer adjusted days from operation to discharge (beta[SE]= -5.2[1.1], P < 0.05) compared to open. Typical benefits seen with minimally-invasive robotic surgery translate to malnourished patients, although they were still prone to longer hospital stay than their adequately nourished counterparts. Robotic approach to RC may help mitigate the increased need for transfusions and longer DOD seen in malnourishment and may be preferable for patients with preoperative nutritional deficits.