Impact of perioperative nutrition on recovery after radical cystectomy: a randomised trial

Abstract

OBJECTIVE: To assess the effect of structured perioperative nutritional optimisation on complication rates, recovery metrics, and body composition in patients undergoing radical cystectomy (RC) with urinary diversion. PATIENTS AND METHODS: In this prospective, randomised controlled trial, 74 patients scheduled for RC were allocated to either a nutritional optimisation group (NOG, n = 37) receiving individualised pre- and postoperative dietary interventions, or a standard care group (SCG, n = 37). Protocol included immunonutrition, caloric/protein adjustment, and close clinical and laboratory monitoring. The primary endpoint was overall complication rates within 30 days. Secondary endpoints included time to gastrointestinal recovery, length of hospital stay, wound healing time, nutritional markers, and body composition measurements. RESULTS: Baseline characteristics were comparable between the groups. Although the overall complication rate was lower in the NOG (54%) than SCG (68%), the difference was not statistically significant (P = 0.236). Nutritional optimisation significantly accelerated gastrointestinal recovery; time to flatus (mean [SD] 39.6 [10.2] vs 64.8 [12.4] h, P < 0.001) and stool passage (mean [SD] 63.4 [12.1] vs 84.2 [13.8] h, P = 0.002) were shorter in the NOG. Length of stay (mean [SD] 7.78 [1.13] vs 10.59 [3.67] days, P = 0.002) and wound healing time (mean [SD] 14.22 [0.92] vs 15.5 [0.88] days, P < 0.001) were also significantly improved. The NOG maintained higher skeletal muscle mass and phase angle measurements at 30 days postoperatively (P ≤ 0.007). CONCLUSIONS: Structured perioperative nutritional optimisation significantly improved gastrointestinal recovery, reduced hospital stay, accelerated wound healing, and preserved skeletal muscle mass in patients undergoing RC.