Perioperative Oral Nutrition Supplementation Reduces Prevalence of Sarcopenia following Radical Cystectomy: Results of a Prospective Randomized Controlled Trial

We designed a prospective randomized controlled pilot trial to investigate the effects of an enriched oral nutrition supplement (ONS) on body composition and clinical outcomes following radical cystectomy (RC). 61 patients were randomized to ONS or multivitamin multimineral supplement (MVI) twice daily during an 8-week perioperative period. Body composition was determined by analysis of abdominal CT images at the L3 vertebra. Sarcopenia was defined as skeletal muscle index <55 cm2/m2 in males and <39 cm2/m2 in females. The primary outcome was difference in 30-day hospital free days (HFDs). Secondary outcomes included hospital length of stay (LOS), complications, readmissions, and mortality. The ONS group lost less weight (-5kg vs -6.5kg, p=0.04) compared to the MVI group. The proportion of patients with sarcopenia did not change in ONS group, but increased 20% in MVI group (p=0.01). Mean LOS and 30-day HFDs were similar between groups. ONS group had a lower rate of overall and major (Clavien grade ≥3) complications (48% vs 67%; 19% vs 25% respectively) and lower readmission rates (17% vs 7%), but the differences did not reach statistical significance. RC patients consuming ONS perioperatively have a reduced prevalence of sarcopenia and may also experience fewer and less severe complications and readmissions. A larger blinded randomized controlled trial is necessary to determine whether ONS interventions can improve outcomes following RC

Biochemical recurrence-free survival after robotic-assisted laparoscopic vs open radical prostatectomy for intermediate- and high-risk prostate cancer

To compare biochemical recurrence (BCR)-free survival and predictors of BCR in intermediate-risk (IR) and high-risk (HR) patients undergoing robotic-assisted laparoscopic prostatectomy (RALP) vs open radical prostatectomy (ORP). We conducted a retrospective study on 1336 men with D'Amico IR or HR prostate cancer who underwent RALP or ORP between 2003 and 2009. Exclusion criteria were use of neoadjuvant therapy, <6 months of follow-up, and insufficient clinicopathologic data. We compared demographic, clinical, and pathologic variables between groups. Kaplan-Meier analysis was performed to compare the 5-year BCR-free survival between groups. Multivariate models were developed to determine whether surgical approach influences BCR. A total of 979 IR and HR patients (237 ORP and 742 RALP patients) met inclusion criteria. Median follow-up was shorter for RALP (43 vs 63 months; P<.001). ORP patients had a higher median prostate-specific antigen level (7.9 vs 6.7 ng/mL; P<.002), significantly more Gleason sum 8-10 tumors, and more adverse pathologic features overall. There was no difference in positive surgical margins between groups. Pathologic features including extraprostatic extension, seminal vesicle involvement, lymph node involvement, pathologic Gleason sum, and positive surgical margin were significant independent predictors of BCR in multivariate analysis. Surgical approach (RALP vs ORP) did not predict BCR when controlling for other known predictors of BCR. Among IR and HR prostate cancer patients, the oncologic outcomes are similar between RALP and ORP. Not surprisingly, adverse pathologic features are harbingers of BCR