Open Access

ARTICLE

Preoperative immunonutrition prior to radical cystectomy: a pilot study

Timothy D. Lyon¹, Robert M. Turner II¹, Dawn McBride¹, Li Wang², Jeffrey R. Gingrich¹, Ronald L. Hrebinko¹, Bruce L. Jacobs¹, Benjamin J. Davies¹, Tatum V. Tarin¹

1 Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
2 Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Address correspondence to Dr. Tatum V. Tarin, Department of Urology, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 700, Pittsburgh, PA 15213 USA

Canadian Journal of Urology 2017, 24(4), 8895-8901.

Abstract

Introduction: To investigate the use of a high-arginine immunonutrient supplement prior to radical cystectomy for bladder cancer.
Materials and methods: We recruited 40 patients to consume a total of four high-arginine immunonutrient shakes per day for 5 days prior to radical cystectomy. The primary outcome measures were safety, tolerability and adherence to the supplementation regimen. Ninety-day postoperative outcomes were also compared between supplemented patients and a cohort of 104 prospectively identified non-supplemented radical cystectomy patients. Multivariable logistic regression models were used to compare overall complications, infectious complications, and readmission rates between groups.
Results: There were no serious adverse events during supplementation. Four patients (10%) stopped supplementation due to nausea (n = 2) and bloating (n = 2). Thirty-three patients (83%) consumed all prescribed shakes. Immunonutrient supplementation was not significantly associated with overall complications (adjusted odds ratio [OR] 1.08; 95% confidence interval [CI] 0.50-2.33), infectious complications (OR 1.23; 95% CI 0.49-3.07), or readmissions (OR 1.48; 95% CI 0.62-3.51) on multivariable analyses.
Conclusions: Preoperative supplementation with a high-arginine immunonutrient shake was safe and well tolerated prior to radical cystectomy. Contrary to prior reports, immunonutrient supplementation was not associated with lower postoperative infectious complications in this cohort, perhaps owing to the 5 day supplementation period. Further study is needed to identify the optimal immunonutrient supplement regimen for radical cystectomy patients.

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