Top

Published in:

01-08-2017 | Original Article

Prospective evaluation of health-related quality of life after radical cystectomy: focus on peri- and postoperative complications

Authors: Alexander Kretschmer, Tobias Grimm, Alexander Buchner, Markus Grabbert, Friedrich Jokisch, Birte-Swantje Schneevoigt, Maria Apfelbeck, Gerald Schulz, Christian G. Stief, Alexander Karl

Published in: World Journal of Urology | Issue 8/2017

Abstract

Objectives

To analyse the impact of perioperative complications and complex treatment courses on postoperative health-related quality of life (HRQOL) after radical cystectomy (RC) and continent (ONB) or incontinent (IC) urinary diversion at multiple prospective time points.

Methods

A total of 121 consecutive patients underwent RC with curative intent between 2013 and 2014. HRQOL was prospectively assessed preoperatively, after 3 and 12 months, using the QLQ-C30 questionnaire. The impact of complex perioperative treatment courses including cases requiring surgical re-interventions was retrospectively assessed using Martin criteria and the Clavien–Dindo scale. Urinary continence was determined using the validated ICIQ-SF questionnaire. Statistical analysis included Kruskal–Wallis ANOVA, Spearman’s rank correlation, and ordinal regression models (p < 0.05).

Results

A total of 100 patients underwent further analysis. Physical functioning (PF), role functioning (RF), and global health status (GHS) scores were higher in the ONB subgroup both preoperatively (p < 0.001, 0.010, 0.048) and 3 months after RC (p = 0.003, 0.048, 0.019). Clavien complications ≥III led to reduced PF levels after 3 months (p = 0.050) without effect on GHS (p = 0.825). Operating time and length of critical care monitoring correlated with 3 months pain scores in the ONB subgroup (p = 0.003, 0.009) without affecting GHS (p = 0.603, 0.653). Continent urinary diversion was an independent predictor of increased HRQOL after 3 months (p = 0.021), however, not after 12 months (p = 0.803).

Conclusions

Patients receiving an IC have lower PF, RF, and GHS scores than those receiving ONB. Perioperative complications and complicated treatment courses can affect HRQOL subdomains but do not significantly impact the GHS. ONB is an independent predictor for better overall HRQOL 3 months, but not 12 months after RC.

Available only for authorised users

Witjes JA, Comperat E, Cowan NC, De Santis M, Gakis G, Lebret T et al (2014) EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol 65(4):778–792. doi:10.1016/j.eururo.2013.11.046 CrossRefPubMed

Porter MP, Penson DF (2005) Health related quality of life after radical cystectomy and urinary diversion for bladder cancer: a systematic review and critical analysis of the literature. J Urol 173(4):1318–1322. doi:10.1097/01.ju.0000149080.82697.65 CrossRefPubMed

Karl A, Buchner A, Becker A, Staehler M, Seitz M, Khoder W et al (2014) A new concept for early recovery after surgery for patients undergoing radical cystectomy for bladder cancer: results of a prospective randomized study. J Urol 191(2):335–340. doi:10.1016/j.juro.2013.08.019 CrossRefPubMed

Zahran MH, El-Hefnawy AS, Zidan EM, El-Bilsha MA, Taha DE, Ali-El-Dein B (2014) Health-related quality of life after radical cystectomy and neobladder reconstruction in women: impact of voiding and continence status. Int J Urol Off J Jpn Urol Assoc 21(9):887–892. doi:10.1111/iju.12452

Kretschmer A, Grimm T, Buchner A, Stief CG, Karl A (2016) Prognostic features for quality of life after radical cystectomy and orthotopic neobladder. Int Braz J Urol Off J Braz Soc Urol 42(6):1109–1120. doi:10.1590/S1677-5538.IBJU.2015.0491 CrossRef

Cerruto MA, D’Elia C, Siracusano S, Gedeshi X, Mariotto A, Iafrate M et al (2016) Systematic review and meta-analysis of non RCT’s on health related quality of life after radical cystectomy using validated questionnaires: better results with orthotopic neobladder versus ileal conduit. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 42(3):343–360. doi:10.1016/j.ejso.2015.10.001

Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376CrossRefPubMed

Fayers PM (2001) Interpreting quality of life data: population-based reference data for the EORTC–QLQ-C30. Eur J Cancer 37(11):1331–1334CrossRefPubMed

Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P (2004) ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn 23(4):322–330. doi:10.1002/nau.20041 CrossRefPubMed

10.

Martin RC, Brennan MF, Jaques DP (2002) Quality of complication reporting in the surgical literature. Ann Surg 235(6):803–813CrossRefPubMedPubMedCentral

11.

Mitropoulos D, Artibani W, Graefen M, Remzi M, Roupret M, Truss M et al (2012) Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations. Eur Urol 61(2):341–349. doi:10.1016/j.eururo.2011.10.033 CrossRefPubMed

12.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral

13.

Cerruto MA, D’Elia C, Siracusano S, Gedeshi X, Mariotto A, Iafrate M et al (2015) Systematic review and meta-analysis of non RCT’s on health related quality of life after radical cystectomy using validated questionnaires: better results with orthotopic neobladder versus ileal conduit. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. doi:10.1016/j.ejso.2015.10.001

14.

Singh V, Yadav R, Sinha RJ, Gupta DK (2014) Prospective comparison of quality-of-life outcomes between ileal conduit urinary diversion and orthotopic neobladder reconstruction after radical cystectomy: a statistical model. BJU Int 113(5):726–732. doi:10.1111/bju.12440 CrossRefPubMed

15.

Ghosh A, Somani BK (2016) Recent trends in postcystectomy health-related quality of life (QoL) favors neobladder diversion: systematic review of the literature. Urology. doi:10.1016/j.urology.2015.12.079

16.

Ritch CR, Cookson MS, Chang SS, Clark PE, Resnick MJ, Penson DF et al (2014) Impact of complications and hospital-free days on health related quality of life 1 year after radical cystectomy. J Urol 192(5):1360–1364. doi:10.1016/j.juro.2014.06.004 CrossRefPubMed

17.

Mansson A, Al Amin M, Malmstrom PU, Wijkstrom H, Abol Enein H, Mansson W (2007) Patient-assessed outcomes in Swedish and Egyptian men undergoing radical cystectomy and orthotopic bladder substitution–a prospective comparative study. Urology 70(6):1086–1090. doi:10.1016/j.urology.2007.07.071 CrossRefPubMed

18.

Novara G, De Marco V, Aragona M, Boscolo-Berto R, Cavalleri S, Artibani W et al (2009) Complications and mortality after radical cystectomy for bladder transitional cell cancer. J Urol 182(3):914–921. doi:10.1016/j.juro.2009.05.032 CrossRefPubMed

19.

Visser MR, Oort FJ, van Lanschot JJ, van der Velden J, Kloek JJ, Gouma DJ et al (2013) The role of recalibration response shift in explaining bodily pain in cancer patients undergoing invasive surgery: an empirical investigation of the Sprangers and Schwartz model. Psycho-oncology 22(3):515–522. doi:10.1002/pon.2114 CrossRefPubMed

20.

Kretschmer A, Grimm T, Buchner A, Grimm J, Grabbert M, Jokisch F et al (2016) Prognostic features for objectively defined urinary continence after radical cystectomy and ileal orthotopic neobladder in a contemporary cohort. J Urol. doi:10.1016/j.juro.2016.08.004 PubMed

21.

Hautmann RE, de Petriconi RC, Volkmer BG (2010) Lessons learned from 1,000 neobladders: the 90-day complication rate. J Urol 184(3):990–994. doi:10.1016/j.juro.2010.05.037 quiz 1235 CrossRefPubMed

22.

Sogni F, Brausi M, Frea B, Martinengo C, Faggiano F, Tizzani A et al (2008) Morbidity and quality of life in elderly patients receiving ileal conduit or orthotopic neobladder after radical cystectomy for invasive bladder cancer. Urology 71(5):919–923. doi:10.1016/j.urology.2007.11.125 CrossRefPubMed

23.

Erber B, Schrader M, Miller K, Schostak M, Baumunk D, Lingnau A et al (2012) Morbidity and quality of life in bladder cancer patients following cystectomy and urinary diversion: a single-institution comparison of ileal conduit versus orthotopic neobladder. ISRN Urol 2012:342796. doi:10.5402/2012/342796 PubMedPubMedCentral

24.

Gacci M, Saleh O, Cai T, Gore JL, D’Elia C, Minervini A et al (2013) Quality of life in women undergoing urinary diversion for bladder cancer: results of a multicenter study among long-term disease-free survivors. Health Qual Life Outcomes 11:43. doi:10.1186/1477-7525-11-43 CrossRefPubMedPubMedCentral

Title: Prospective evaluation of health-related quality of life after radical cystectomy: focus on peri- and postoperative complications
Authors: Alexander Kretschmer
Tobias Grimm
Alexander Buchner
Markus Grabbert
Friedrich Jokisch
Birte-Swantje Schneevoigt
Maria Apfelbeck
Gerald Schulz
Christian G. Stief
Alexander Karl
Publication date: 01-08-2017
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 8/2017
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-016-1992-2

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Prospective evaluation of health-related quality of life after radical cystectomy: focus on peri- and postoperative complications

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2017

First clinical evaluation of a new single-use flexible cystoscope dedicated to double-J stent removal (Isiris™): a European prospective multicenter study

Improved decision making in intermediate-risk prostate cancer: a multicenter study on pathologic and oncologic outcomes after radical prostatectomy

Platinum-refractory germ cell tumors: an update on current treatment options and developments

High-dose chemotherapy as salvage treatment in germ-cell cancer: when, in whom and how

Erratum to: Focal salvage therapy for local prostate cancer recurrences after primary radiotherapy: a comprehensive review

Residual tumor resection (RTR)