The Impact of Sarcopenia on Morbi-Mortality in Patients who Underwent Radical Cystectomy for Bladder Cancer

Abstract

Context: Sarcopenia is a physiological alteration defined as a loss of skeletal muscle mass as a result of fragility due to aging or neoplastic pathology. Aims: The aim of this work was to evaluate whether sarcopenia was predictive of morbidity and mortality in patients undergoing radical cystectomy for bladder tumor. Study Design: Monocentric prospective study. Place and Duration of Study: Department of Urology and Department of Radiology, at the Ibn Rochd University Hospital, between January 2021 and June 2022. Methodology: A single-center prospective study was conducted, including patients treated by radical cystectomy between January 2021 and June 2022. Of the 85 patients listed in our study, 74 were selected for inclusion. Sarcopenia was retained according to Martin's definition, which takes into account striated muscle area on a CT cross-section passing through the 3rd lumbar vertebra. Short- and long-term post-operative follow-up was performed, and complications were classified according to the Clavien Dindo classification adapted to radical cystectomy. Results: The average age of our patients was 68.70 years. Sarcopenic patients accounted for 48.6%. No association was observed between sarcopenia and the occurrence of complications in the immediate and 1-month operative follow-up. However, a strong association was noted at the 3-month and 1-year follow-up. Furthermore, sarcopenia was correlated with mortality in our sample (p<0.05). Conclusion: Sarcopenia was identified as an independent preoperative prognostic factor for morbidity and mortality. Therefore, a trimodal treatment (trans-urethral resection of the bladder + chemotherapy + radiotherapy) in the most fragile patients would be more beneficial than radical cystectomy, due to the morbidities and complications involved.