Mp41-19 the Effect of Smoking on Radical Cystectomy Surgical Outcomes: a Propensity-matched Analysis
Year: 2018
Type: article
Study design: Observational Study
Abstract: INTRODUCTION AND OBJECTIVES: Quality of life is an important consideration after complex cancer surgery.Data on quality of life after radical cystectomy are still scarce.Our aim was to analyse the impact of robotic assisted radical cystectomy (RARC) and urinary diversion with multimodal enhanced recovery protocol on peri-operative outcomes and postoperative health-related quality of life (HRQOL) at multiple prospective time points.METHODS: A total of 240 consecutive patients underwent RARC after the establishment of a new tertiary cystectomy service in April 2013.HRQOL was prospectively assessed preoperatively, after 6 and 12 months, using the QLQ-C30 questionnaire.Analysis of outcomes to demographic and perioperative variables was performed.RESULTS: The median age at treatment was 71 years old, 76% were males, 72% had a BMI <30kg/m2, 81% an ASA score 2 and 72% a CPET anaerobic threshold 11.The median LOS was 5 days (1st-3rd IQR: 4-7 days).Post-operative day 4 was the most frequent day of discharge from hospital.The incidence of post-operative complications was 42% for minor (Clavien-Dindo grade II) and 8% for major (grade III) complications.Major complications led to reduced physical functioning (PF) levels after 6 months (p ¼ 0.050) without effect on global health status (GHS) (p ¼ 0.825).HRQOL seems to improve to similar or better levels compared to baseline after 1 year.Subgroup analysis revealed greater improvement in PF in intra vs extra corporeal diversion (p ¼ 0.049) but no differences between neobladder and ileal conduit.CONCLUSIONS: Perioperative complications and complicated recovery after RARC can affect HRQOL subdomains but do not significantly influence the GHS.Post operative QOL invariably improves in 1 year after surgery while patient reported outcomes are comparable after either continent or incontinent urinary diversion.Totally intracorporeal minimal invasive approach followed by multimodal enhanced recovery programme is ensuring better short and long term overall HRQOL outcomes.Selection of diversion should be tailored to patient 0 s preference after comprehensive counselling with multidisciplinary team since there is no demonstrable benefit of continent reconstruction.
Source: The Journal of Urology
Authors: Niranjan Sathianathen, Badrinath Konety
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2795551185