Immunonutrition in Radical Cystectomy: State of the Art and Perspectives

SIMPLE SUMMARY: Preoperative nutritional status is a pivotal aspect to consider in cancer patients undergoing radical cystectomy, as malnourished individuals are more prone to post-surgical complications. The loss of muscle mass is a significant consequence of cancer-related malnutrition and is associated with increased risks of readmission, longer hospital stays, and higher mortality rates. This narrative review explores the concept of “immunonutrition”, which consists of the use of specific nutrients to boost the immune system and improve postoperative outcomes. By reviewing existing scientific literature, promising evidence was found that supports immunonutrition in reducing complications, including infections, after bladder surgery. These findings highlight the need for further research to determine the optimal approach, regardless of nutritional status, for improving patient outcomes after bladder surgery. The development of uniformly designed randomized controlled trials is necessary to establish the most effective dosage, timing, and duration of perioperative immunonutrition and to confirm the available preliminary evidence. ABSTRACT: Preoperative nutritional status is a pivotal aspect to consider in patients with cancer undergoing radical cystectomy (RC), as those at risk of malnutrition or already malnourished are more prone to post-surgical complications. The loss of muscle mass is a major consequence of cancer-related malnutrition. It is associated with increased risk of hospital readmission, longer hospitalization, and higher mortality. Nowadays, the close relationship between nutritional and immunological aspects under stressful conditions, such as surgery, represents an emerging scientific and clinical issue. Indeed, the synergistic action of reduced food intake and systemic inflammation generates metabolic derangements with tissue catabolism, including skeletal muscle breakdown, which is, in turn, associated with immune system dysfunction. In order to offer an additional immune-nutritional boost to the post-surgical phase, particularly in malnourished patients, nutritional support may include oral nutritional supplements and/or enteral formulas enriched with specific nutrients such as omega-3 fatty acids, arginine, glutamine, and nucleotides, with acknowledged immune-modulating effects. In the present narrative review, we addressed the state of the art of the available scientific literature on the benefit of immunonutrition in patients undergoing RC for cancer and suggest possible future perspectives to be explored. Although the role of immunonutrition was found to be little explored in the context of urologic oncology, the preliminary available data on radical cystectomy, summarized in the present paper, are promising and suggest that it may improve postoperative outcomes through immunomodulation, regardless of nutritional status before surgery.