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Frailty is significantly associated with the type of urinary diversion in patients with muscle‐invasive bladder cancer
Author(s) -
Okita Kazutaka,
Hatakeyama Shingo,
Momota Masaki,
Soma Osamu,
Hamano Itsuto,
Tanaka Toshikazu,
Iwamura Hiromichi,
Fujita Naoki,
Okamoto Teppei,
Yamamoto Hayato,
Yoneyama Takahiro,
Hashimoto Yasuhiro,
Yoshikawa Kazuaki,
Kawaguchi Toshiaki,
Ohyama Chikara
Publication year - 2020
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.14263
Subject(s) - medicine , cystectomy , urinary diversion , bladder cancer , urinary system , proportional hazards model , urology , cancer , oncology , surgery
Objectives To investigate the effect of frailty on the type of urinary diversion after radical cystectomy in patients with muscle‐invasive bladder cancer. Methods Between January 2014 and January 2020, we prospectively evaluated frailty in 88 patients with localized muscle‐invasive bladder cancer, who had received radical cystectomy and urinary diversion. The selection of the type of urinary diversion was determined by the operating surgeon based on performance status, comorbidities, tumor status and the patient’s preference. The frailty evaluation included the Fried phenotype criteria, the modified frailty index and the frailty discriminant score. We investigated the association between frailty and type of urinary diversion, the effect of frailty on postoperative complications and the effect of frailty on overall survival. Results The median age of the selected participants was 68 years. The number of patients with an orthotopic neobladder and any postoperative complications was 54 (61%) and 46 (52%), respectively. Of the frailty assessment tools that were used, Fried phenotype criteria and frailty discriminant score were significantly associated with the selection of non‐orthotopic neobladder urinary diversion. Occurrences of postoperative complications in participants were significantly associated with modified frailty index, but not with Fried phenotype criteria and frailty discriminant score. Multivariate Cox regression analysis showed that a higher frailty discriminant score was significantly associated with poor overall survival, whereas higher Fried phenotype criteria and modified frailty index were not. Conclusion Frailty is significantly associated with the type of urinary diversion, and it should be considered for the selection of urinary diversion in muscle‐invasive bladder cancer patients undergoing radical cystectomy.