Introduction: Patients undergoing urinary radical cystectomy (RC) and urinary diversion for bladder cancer had some limitations in health-related quality of life (HRQOL). At present there are not sufficient studies to evaluate the levels of discomfort caused by different urinary diversion in survivors The aim of this study was to evaluate differences in HRQOL between patients with bladder cancer undergoing orthotopic ileal neobladder (IONB) and ileal conduit (IC) after RC (1). Patients and Methods: A total of 319 consecutive patients with bladder cancer (271 males and 48 females) underwent RC from five urological academic centres with subsequent urinary diversion (171 with IONB and 148 with IC) from June 2007 to September 2012 with no evidence of tumor recurrences and with active follow-up were enrolled in this study. Clinical and pathological data as well as oncological outcome were retrospectively analyzed and compared. HRQOL was analyzed using Italian version of EORTC QLQ- 30 and EORTC QLQ BLM30 questionnaires. Clinical data were analyzed in order to evaluate the HRQOL differences between the two groups of patients. As null hypothesis was assumed that there was no differences between two of the urinary diversion groups in terms of HRQOL. Means values with standard deviations (±SD) were assessed for all items. Wilcoxon rank test was used to verify differences between two diversion groups. Statistical significance was achieved if p -value was ≤0.05 (two-sides). Results: Patients who underwent IONB was youngest than IC patients: median age were 66 years (range: 31-83) and 71 (range: 49-95) respectively. No significant differences were found in the pTNM – UICC stage (stage 0-I were 36.8% for IONB and 33.8% for IC) and in the follow-up (38 months and 35 months for IONB and IC respectively). Patients with IC showed a significant worsening in physical functioning (80.8±22.2 vs . 74.7±24.8 - p= 0.006), in emotional functioning (84.9±20.9 vs . 78.7±24.7 - p= 0.02), in cognitive functioning (93.1±12.6 vs . 85.4±21.2 - p= 0.0002) in comparison with IONB. Patients with IC had high level of troubles in fatigue (19.5±21.4 vs . 29.6±27.0 - p= 0.0006), in dyspnea (12.9±22.1 vs . 20.5±27.1 - p= 0.007), in appetite loss (6.7±17.2 vs . 14.2±27.5 - p= 0.01), in constipation (16.0±21.4 vs . 31.5±34.7 - p< 0.0001), and in abdominal bloating flatulence (11.8±19.9 vs . 25.5±26.5 - p< 0.0001) in comparison with IONB. Discussion and Conclusion: The patients with IC showed a higher number of troubles in comparison with the IONB group. In particular the patients with IONB seem to be able to improve their activity during the life contrary to the IC group. Cystectomy with any type of diversion remains a complication-prone surgery, nevertheless our results showed that IC showed higher troubles than IONB.
LONG-TERM FOLLOW-UP AND HRQOL IN PATIENTS UNDERGOING RADICAL CYSTECTOMY: STATISTICAL AND CLINICAL ISSUES
CERRUTO, Maria Angela;LONARDI, Cristina;
2014-01-01
Abstract
Introduction: Patients undergoing urinary radical cystectomy (RC) and urinary diversion for bladder cancer had some limitations in health-related quality of life (HRQOL). At present there are not sufficient studies to evaluate the levels of discomfort caused by different urinary diversion in survivors The aim of this study was to evaluate differences in HRQOL between patients with bladder cancer undergoing orthotopic ileal neobladder (IONB) and ileal conduit (IC) after RC (1). Patients and Methods: A total of 319 consecutive patients with bladder cancer (271 males and 48 females) underwent RC from five urological academic centres with subsequent urinary diversion (171 with IONB and 148 with IC) from June 2007 to September 2012 with no evidence of tumor recurrences and with active follow-up were enrolled in this study. Clinical and pathological data as well as oncological outcome were retrospectively analyzed and compared. HRQOL was analyzed using Italian version of EORTC QLQ- 30 and EORTC QLQ BLM30 questionnaires. Clinical data were analyzed in order to evaluate the HRQOL differences between the two groups of patients. As null hypothesis was assumed that there was no differences between two of the urinary diversion groups in terms of HRQOL. Means values with standard deviations (±SD) were assessed for all items. Wilcoxon rank test was used to verify differences between two diversion groups. Statistical significance was achieved if p -value was ≤0.05 (two-sides). Results: Patients who underwent IONB was youngest than IC patients: median age were 66 years (range: 31-83) and 71 (range: 49-95) respectively. No significant differences were found in the pTNM – UICC stage (stage 0-I were 36.8% for IONB and 33.8% for IC) and in the follow-up (38 months and 35 months for IONB and IC respectively). Patients with IC showed a significant worsening in physical functioning (80.8±22.2 vs . 74.7±24.8 - p= 0.006), in emotional functioning (84.9±20.9 vs . 78.7±24.7 - p= 0.02), in cognitive functioning (93.1±12.6 vs . 85.4±21.2 - p= 0.0002) in comparison with IONB. Patients with IC had high level of troubles in fatigue (19.5±21.4 vs . 29.6±27.0 - p= 0.0006), in dyspnea (12.9±22.1 vs . 20.5±27.1 - p= 0.007), in appetite loss (6.7±17.2 vs . 14.2±27.5 - p= 0.01), in constipation (16.0±21.4 vs . 31.5±34.7 - p< 0.0001), and in abdominal bloating flatulence (11.8±19.9 vs . 25.5±26.5 - p< 0.0001) in comparison with IONB. Discussion and Conclusion: The patients with IC showed a higher number of troubles in comparison with the IONB group. In particular the patients with IONB seem to be able to improve their activity during the life contrary to the IC group. Cystectomy with any type of diversion remains a complication-prone surgery, nevertheless our results showed that IC showed higher troubles than IONB.
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