ABSTRACT

Aim:

Radical cystectomy is a treatment method, which is accepted as a major operative procedure and carries severe potential risks. Nutritional insufficiency is generally a well-known risk factor for complications like infection and wound healing in surgical cases, and it can affect perioperative mortality and overall survival. Patients, who had radical cystectomy, have been applied with a bad nutritional status at a high rate of 19%. Immunonutrition is defined as improvement of immune system by giving specific foods. The most commonly employed nutrients for immunonutrition are arginine, glutamine, branch chained amino acids, n-3 fatty acids, and nucleotides. It is aimed to emphasize delivering the significance of immunonutrient foods in pre- and postoperative periods in radical cystectomy patients.

New results:

Serum albumin is frequently a part of nutritional evaluation, and preoperative low serum albumin level is related to increased mortality rate in different surgical patient groups including radical cystectomy. Although albumin is beneficial in evaluating protein synthesis in chronic diseases, it is not a correct marker for acute nutritional insufficiency, because its half life is 20 days. Having shorter half lives, pre-albumin and transferrin have been proposed as alternatives to albumin. In Nutritional Risk Index, objective criteria are required to evaluate nutritional state of patients, who would undergo major surgical operations like radical cystectomy. Albumin and weight loss are used to calculate risk preoperatively in Nutritional Risk Index. Body mass index, weight loss, appetite, dysphagia, and disease severity are used to decide on the risk more subjectively in Nutritional Risk Score (NRS). These have been shown to predict severity and incidence of postoperative complications. A version of NRS is specifically designed for urology patients.

Conclusion:

Nutritional states of patients, who are planned to undergo radical cystectomy, should be evaluated well. Oral or enteral supportive immunonutrition in preoperative period may improve mortality rate and bad prognosis. Therefore, immunonutrition should be considered to be given in operations with high morbidity and mortality rates like radical cystectomy.