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Prospective evaluation of health-related quality of life after radical cystectomy: focus on peri- and postoperative complications

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Abstract

Objectives

To analyse the impact of perioperative complications and complex treatment courses on postoperative health-related quality of life (HRQOL) after radical cystectomy (RC) and continent (ONB) or incontinent (IC) urinary diversion at multiple prospective time points.

Methods

A total of 121 consecutive patients underwent RC with curative intent between 2013 and 2014. HRQOL was prospectively assessed preoperatively, after 3 and 12 months, using the QLQ-C30 questionnaire. The impact of complex perioperative treatment courses including cases requiring surgical re-interventions was retrospectively assessed using Martin criteria and the Clavien–Dindo scale. Urinary continence was determined using the validated ICIQ-SF questionnaire. Statistical analysis included Kruskal–Wallis ANOVA, Spearman’s rank correlation, and ordinal regression models (p < 0.05).

Results

A total of 100 patients underwent further analysis. Physical functioning (PF), role functioning (RF), and global health status (GHS) scores were higher in the ONB subgroup both preoperatively (p < 0.001, 0.010, 0.048) and 3 months after RC (p = 0.003, 0.048, 0.019). Clavien complications ≥III led to reduced PF levels after 3 months (p = 0.050) without effect on GHS (p = 0.825). Operating time and length of critical care monitoring correlated with 3 months pain scores in the ONB subgroup (p = 0.003, 0.009) without affecting GHS (p = 0.603, 0.653). Continent urinary diversion was an independent predictor of increased HRQOL after 3 months (p = 0.021), however, not after 12 months (p = 0.803).

Conclusions

Patients receiving an IC have lower PF, RF, and GHS scores than those receiving ONB. Perioperative complications and complicated treatment courses can affect HRQOL subdomains but do not significantly impact the GHS. ONB is an independent predictor for better overall HRQOL 3 months, but not 12 months after RC.

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Abbreviations

ECOG:

Eastern Cooperative Oncology Group

EORTC:

European Organization for Research on Treatment of Cancer

FSFI-6:

Female Sexual Function Index

HRQOL:

Health-related quality of life

IC:

Ileum conduit

ICU:

Intensive care unit

ICIQ-SF:

International Consultation on Incontinence Questionnaire short form

IIEF-5:

International Index of Erectile Function Questionnaire

ONB:

Neobladder

QLQ-C30:

Quality of Life Questionnaire C30

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Authors’ contributions

Alexander Kretschmer was involved in protocol/project development, data collection and management, data analysis, manuscript writing. Tobias Grimm, Alexander Buchner, Christian G. Stief, and Alexander Karl were involved in protocol development, data collection and management, manuscript editing. Markus Grabbert, Friedrich Jokisch, Birte-Swantje Schneevoigt, Maria Apfelbeck, and Gerald Schulz contributed to data collection and management, manuscript editing.

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Authors and Affiliations

  1. Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany

    Alexander Kretschmer, Tobias Grimm, Alexander Buchner, Markus Grabbert, Friedrich Jokisch, Birte-Swantje Schneevoigt, Maria Apfelbeck, Gerald Schulz, Christian G. Stief & Alexander Karl

  2. Department of Urological Sciences, The Vancouver Prostate Centre, University of British Columbia, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada

    Alexander Kretschmer

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  1. Alexander Kretschmer
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Correspondence to Alexander Kretschmer.

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The authors declare that the study has been approved by an institutional review board and follows the Declaration of Helsinki of 1964. No participant was included without a signed informed consent.

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Kretschmer, A., Grimm, T., Buchner, A. et al. Prospective evaluation of health-related quality of life after radical cystectomy: focus on peri- and postoperative complications. World J Urol 35, 1223–1231 (2017). https://doi.org/10.1007/s00345-016-1992-2

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  • DOI: https://doi.org/10.1007/s00345-016-1992-2

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