L-arginine supplementation helps prevent infection after radical cystectomy

Postoperative infection is one of the most common complications of radical cystectomy, but preoperative immunonutrition with an L-arginine-based supplement appears to significantly reduce such risk, according to a study.

A team of investigators carried out a retrospective review of 204 patients who underwent radical cystectomy for bladder cancer at a single institution and compared those who received oral L-arginine-based preoperative immunonutrition supplementation (pre-INS) with those who did not. They also obtained preoperative feature, postoperative complications, and readmission data.

The following outcomes were noted: high-grade (Clavien-Dindo III–V) complications, readmission within 30 days, ileus, total parenteral nutrition (TPN) requirement, postoperative infection, and length of stay (LOS). The investigators assessed categorial and continuous outcomes using Fisher’s exact test and Welch T-test, respectively, and identified predictors via multivariable logistic regression analysis.

The likelihood of requiring postoperative TPN (17.3 percent vs 35.6 percent; odds ratio [OR], 0.38) and developing postoperative infection (25 percent vs 45 percent; OR, 0.41; p=0.003) was significantly lower among patients who received pre-INS, but no significant differences were seen in other outcomes.

After adjusting for age, gender, body mass index, Charlson comorbidity index, neoadjuvant chemotherapy, and operative features, multivariate analysis revealed that pre-INS was significantly predictive of postoperative infection (OR, 0.35; p=0.02), but not of high-grade complications, readmission, ileus, needing TPN, or LOS.

“Radical cystectomy for the management of muscle-invasive bladder cancer remains a morbid procedure with high rates of perioperative complications,” the investigators said.