Page 3 - CUA2018 Abstracts - Oncology-Bladder

Poster session 5: Other Oncology I

objectives included process and outcome measures, such as referral pat- 3. Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recov-
terns to medical oncology (MO), receipt of perioperative chemotherapy, ery after surgery: A consensus review of clinical care for patients
and postoperative mortality. undergoing colonic resection. Clin Nutr 2005;24:466–77. https://
Results: A total of 5582 RCs were completed in Ontario over the study doi.org/10.1016/j.clnu.2005.02.002
period: 3879 (69%) in 1994–2008 and 1703 (31%) in 2009–2013. 4. Lemanu DP, Singh PP, Stowers MD, et al. A systematic review to
The mean annual surgeon volume and hospital volume of RC during assess cost effectiveness of enhanced recovery after surgery pro-
1994–2008 was 4.17 (95% confidence interval [CI] 3.36–4.98) and 11.33 grammes in colorectal surgery. Colorectal Dis 2014;16:338–46.
(95% CI 9.44–13.22), respectively. In the more contemporary era, these https://doi.org/10.1111/codi.12505
volumes significantly increased to 6.80 (95% CI 6.47–7.33) and 16.40 5. Sarin A, Litonius ES, Naidu, R, et al. Successful implementation of
(95% CI 15.39–17.40) (p<0.01) (Fig. 1; available at https://cua.guide/). an Enhanced Recovery After Surgery program shortens length of stay
Preoperative MO referral increased from 11% in 1994–2008 to 32% in and improves postoperative pain, and bowel and bladder function
2009–2013 (p<0.01). Use of neoadjuvant chemotherapy increased sub- after colorectal surgery. BMC Anesthesiol 2016;16:55. https://doi.
stantially from 4% in 1994–2008 to 19% in 2009–2013 (p<0.001). There org/10.1186/s12871–016–0223–0
was a trend towards decreased 90–day postoperative mortality: 7.59% in 6. Patel HR, Cerantola Y, Valerio M, et al. Enhanced recovery after
2009–2013 vs. 8.27% in 1994–2008. surgery: are we ready, and can we afford not to implement these
Conclusions: These data illustrate passive consolidation of cystectomy pathways for patients undergoing radical cystectomy? Eur Urol
to higher–volume providers in Ontario. During the same time period, 2014;65:263–6. https://doi.org/10.1016/j.eururo.2013.10.011
there has been improvements in other processes of care. Further work
is required to determine the potential effects of centralization on other MP–5.8
process–related quality indicators and patient outcomes
Do men with prior military service have an increased risk for
genitourinary cancers? Results from the HINTS national database
MP–5.7 Hanan Goldberg , Thenappan Chandrasekar , Zachary Klaassen ,
1
1
1
Postoperative ileus and complications outcomes in the enhanced Christopher Wallis , Jaime Omar Herrera Cáceres , Dixon Woon , Girish
1
1
1
recovery protocol after radical cystectomy for bladder cancer Kulkarni , Robert Hamilton , Nathan Perlis , Antonio Finelli , Alexandre
1
1
1
1
Ioana Fugaru , Louis Lacombe , Yves Fradet , Vincent Fradet , Julie Berger , Zlotta , Neil Fleshner 1
1
2
1
2
2
2
Paul Toren , Michele Lodde 2 1 Surgical Oncology, Urology Division, Princess Margaret Cancer Centre,
2
1 Faculté de Médecine, Université Laval, Quebec City, QC, Canada; Toronto, ON, Canada
2 Centre Hospitalier Universitaire de Québec, Hôpital de l’Hôtel–Dieu Introduction: Small series have demonstrated that the incidence of select
de Québec, Université Laval, Quebec City, QC, Canada malignancies are higher among military personnel than the non–military
Introduction: Radical cystectomy (RC) is associated with high morbidity population. Using a national survey database, we assess whether any his-
rates. 1,2 Enhanced Recovery After Surgery (ERAS) programs standardize tory of military service among men was associated with an increased inci-
and decrease length of stay (LOS), postoperative ileus (POI), pain, and dence of cancers in general and genitourinary (GU) cancers specifically.
readmissions in colorectal surgery. 3–5 ERAS protocols allow fluid and car- Methods: This was a cross–sectional study, using the Health Information
bohydrate loading up to two hours preoperatively and encourage early National Trends Survey (HINTS, 4th Ed.), a population–based survey of
oral postoperative nutrition. In RC, ERAS protocols are accepted mostly people living in the U.S. during the years 2011–2014. Eligible individu-
based on the favourable results observed in colorectal surgery. Our study als were men aged 18 and above, who were stratified according to their
6
aims to assess POI, oral feeding, and complication outcomes between an military service history into the following categories: current active duty,
ERAS protocol and the traditional management after RC. active duty in the last 12 months, active duty >12 months ago, Reserve or
Methods: We retrospectively reviewed 40 patients who underwent RC National Guard duty only, and no military history. Multivariable logistic
under an ERAS protocol and 40 patients under conservative management regression analysis was performed to assess for predictors of GU cancers.
(control group) at the Hôtel–Dieu de Québec between 2016 and 2017. Results: A total of 4715 men aged 18 and above were included in the
Data was analyzed using GraphPad Prism 7 software. Nasogastric tube study. Table 1 (available at https://cua.guide/) demonstrates the demo-
(NGT) use, total parental nutrition (TPN) use, LOS, and complications graphic characteristics of all patients. Mean age was significantly higher
were compared between the two protocols. in men with military history (MMH), with a resulting higher proportion
Results: POI rates were higher in the ERAS group compared to the control of retired men. Fig. 1 (available at https://cua.guide/) demonstrates that
group (57.5 vs. 47.5%). Slightly more patients underwent NGT installa- among MMH, there is significant higher rate of cancer in general and
tion in the ERAS group (52.5%) compared to the control group (45%; GU cancers specifically, mainly driven by a higher incidence of prostate
p=0.6549). Early installation of NGT was more frequent in the ERAS group cancer. MMH were also demonstrated to have a higher rate of additional
(12.5 vs. 0% one day post–RC). Use of TPN was less frequent in the ERAS cancer, aside from GU cancer. On multivariable analysis, age, black race,
group compared to the control (27.5 vs. 37.5%; p=0.4743). However, being retired, and having a history of military service were all predictors
median TPN duration was greater in the ERAS group compared to the of GU cancers (Table 2; available at https://cua.guide/).
control (13 vs. 6 days). Within a week from RC, 65% of ERAS patients Conclusions: Despite an obvious selection bias, this hypothesis–gener-
tolerated oral nutrition compared to 52.5% control patients (p=0.4978). ating study suggest that a history of U.S. military service seems to be
Median LOS was identical in both groups (11 days). Complication and associated with a higher incidence of GU cancers among men in the
readmission rates were similar in both groups. HINTS database, mainly driven by prostate cancer. Further studies are
Conclusions: This study does not support significant improvements in out- needed to elucidate the correlation between cancer and any kind of
comes in patients under ERAS protocols for RC. Further multicentre stud- previous military service.
ies are warranted to clarify this observation and to improve postoperative
management of RC patients.
References:
1. Roth B, Birkhauser FD, Zehnder, P, et al. Parenteral nutrition does
not improve postoperative recovery from radical cystectomy: Results
of a prospective randomized trial. Eur Urol 2013;63:475–82. https://
doi.org/10.1016/j.eururo.2012.05.052
2. Shabsigh A, Korets R, Vora K, et al. Defining early morbidity of radi-
cal cystectomy for patients with bladder cancer using a standard-
ized reporting methodology. Eur Urol 2009;55:164–74. https://doi.
org/10.1016/j.eururo.2008.07.031
CUAJ • June 2018 • Volume 12(6Suppl2) S91