Диета После Удаления Мочевого Пузыря
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Summary of findings for the main comparison . Postoperative parenteral nutrition compared to oral nutrition alone for the treatment of bladder cancer by radical cystectomy
Summary of findings 2 . Immunonutrition compared to standard nutritional supplements for the treatment of bladder cancer by radical cystectomy
Summary of findings 3 . Preoperative oral nutritional support compared to normal diet for the treatment of bladder cancer by radical cystectomy
Summary of findings 4 . Early postoperative feeding compared to standard management for the treatment of bladder cancer by radical cystectomy
Summary of findings 5 . Amino acid solution, alone or in combination with dextrose compared to dextrose solution for the treatment of bladder cancer by radical cystectomy
Summary of findings 6 . Branch chain amino acids compared to dextrose for the treatment of bladder cancer by radical cystectomy
Summary of findings 7 . Oral nutritional supplements compared to multivitamin and mineral supplement for treatment of bladder cancer by radical cystectomy
Table 1 . Description of interventions
Table 2 . Baseline characteristics
Summary of findings for the main comparison . Postoperative parenteral nutrition compared to oral nutrition alone for the treatment of bladder cancer by radical cystectomy
Summary of findings for the main comparison . Postoperative parenteral nutrition compared to oral nutrition alone for the treatment of bladder cancer by radical cystectomy
Summary of findings 2 . Immunonutrition compared to standard nutritional supplements for the treatment of bladder cancer by radical cystectomy
Summary of findings 2 . Immunonutrition compared to standard nutritional supplements for the treatment of bladder cancer by radical cystectomy
Summary of findings 3 . Preoperative oral nutritional support compared to normal diet for the treatment of bladder cancer by radical cystectomy
Summary of findings 3 . Preoperative oral nutritional support compared to normal diet for the treatment of bladder cancer by radical cystectomy
Summary of findings 4 . Early postoperative feeding compared to standard management for the treatment of bladder cancer by radical cystectomy
Summary of findings 4 . Early postoperative feeding compared to standard management for the treatment of bladder cancer by radical cystectomy
Summary of findings 5 . Amino acid solution, alone or in combination with dextrose compared to dextrose solution for the treatment of bladder cancer by radical cystectomy
Summary of findings 5 . Amino acid solution, alone or in combination with dextrose compared to dextrose solution for the treatment of bladder cancer by radical cystectomy
Summary of findings 6 . Branch chain amino acids compared to dextrose for the treatment of bladder cancer by radical cystectomy
Summary of findings 6 . Branch chain amino acids compared to dextrose for the treatment of bladder cancer by radical cystectomy
Summary of findings 7 . Oral nutritional supplements compared to multivitamin and mineral supplement for treatment of bladder cancer by radical cystectomy
Summary of findings 7 . Oral nutritional supplements compared to multivitamin and mineral supplement for treatment of bladder cancer by radical cystectomy
Table 1 . Description of interventions
Table 1 . Description of interventions
Table 2 . Baseline characteristics
Table 2 . Baseline characteristics
Comparison 1 . Postoperative parenteral nutrition compared to standard care
Comparison 1 . Postoperative parenteral nutrition compared to standard care
Comparison 2 . Immunonutrition compared to standard oral nutritional supplements
Comparison 2 . Immunonutrition compared to standard oral nutritional supplements
Comparison 3 . Preoperative oral nutritional support compared to normal diet
Comparison 3 . Preoperative oral nutritional support compared to normal diet
Comparison 4 . Early postoperative feeding compared to standard postoperative management
Comparison 4 . Early postoperative feeding compared to standard postoperative management
Comparison 5 . Amino acid solution, alone or in combination with dextrose, compared to dextrose solution
Comparison 5 . Amino acid solution, alone or in combination with dextrose, compared to dextrose solution
Comparison 6 . Perioperative oral nutritional supplements compared to oral multivitamin and mineral supplement
Comparison 6 . Perioperative oral nutritional supplements compared to oral multivitamin and mineral supplement
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Version published: 20 May 2019 Version history
Radical cystectomy (RC) is the primary surgical treatment for muscle‐invasive urothelial carcinoma of the bladder . This major operation is typically associated with an extended hospital stay, a prolonged recovery period and potentially major complications . Nutritional interventions are beneficial in some people with other types of cancer and may be of value in this setting too .
To assess the effects of perioperative nutrition in people undergoing radical cystectomy for the treatment of bladder cancer .
We performed a comprehensive search using multiple databases (Evidence Based Medicine Reviews, MEDLINE, Embase, AMED, CINAHL), trials registries, other sources of grey literature, and conference proceedings published up to 22 February 2019, with no restrictions on the language or status of publication .
We included parallel‐group randomised controlled trials (RCTs) of adults undergoing RC for bladder cancer . The intervention was any perioperative nutrition support .
Two review authors independently assessed studies for inclusion, extracted data, and assessed risk of bias and the quality of evidence using GRADE . Primary outcomes were postoperative complications at 90 days and length of hospital stay . The secondary outcome was mortality up to 90 days after surgery . When 90‐day outcome data were not available, we reported 30‐day data .
The search identified eight trials including 500 participants . Six trials were conducted in the USA and two in Europe .
1 . Parenteral nutrition (PN) versus oral nutrition: based on one study with 157 participants, PN may increase postoperative complications within 30 days (risk ratio (RR) 1 .40, 95% confidence interval (CI) 1 .07 to 1 .82; low‐quality evidence) . We downgraded the quality of evidence for serious study limitations (unclear risk of selection, performance and selective reporting bias) and serious imprecision . This corresponds to 198 more complications per 1000 participants (95% CI 35 more to 405 more) . Length of hospital stay may be similar (mean difference (MD) 0 .5 days higher, CI not reported; low‐quality evidence) .
2 . Immuno‐enhancing nutrition versus standard nutrition: based on one study including 29 participants, immuno‐enhancing nutrition may reduce 90‐day postoperative complications (RR 0 .31, 95% CI 0 .08 to 1 .23; low‐quality evidence) . These findings correspond to 322 fewer complications per 1000 participants (95% CI 429 fewer to 107 more) . Length of hospital stay may be similar (MD 0 .20 days, 95% CI 1 .69 lower to 2 .09 higher; low‐quality evidence) . We downgraded the quality of evidence of both outcomes for very serious imprecision .
3 . Preoperative oral nutritional support versus normal diet: based on one study including 28 participants, we are very uncertain if preoperative oral supplements reduces postoperative complications . We downgraded quality for serious study limitations (unclear risk of selection, performance, attrition and selective reporting bias) and very serious imprecision . The study did not report on length of hospital stay .
4 . Early postoperative feeding versus standard postoperative management: based on one study with 102 participants, early postoperative feeding may increase postoperative complications (very low‐quality evidence) but we are very uncertain of this finding . We downgraded the quality of evidence for serious study limitations (unclear risk of selection and performance bias) and very serious imprecision . Length of hospital stay may be similar (MD 0 .95 days less, CI not reported; low‐quality evidence) . We downgraded the quality of evidence for serious study limitations (unclear risk of selection and performance bias) and serious imprecision .
5 . Amino acid with dextrose versus dextrose: based on two studies with 104 participants, we are very uncertain whether amino acids reduce postoperative complications (very low‐quality evidence) . We are also very uncertain whether length of hospital stay is similar (very low‐quality evidence) . We downgraded the quality of evidence for both outcomes for serious study limitations (unclear and high risk of selection bias; unclear risk of performance, detection and selective reporting bias), serious indirectness related to the patient population and very serious imprecision .
6 . Branch chain amino acids versus dextrose only: based on one study including 19 participants, we are very uncertain whether complication rates are similar (very low‐quality evidence) . We downgraded the quality of evidence for serious study limitations (unclear risk of selection, performance, detection, attrition and selective reporting bias), serious indirectness related to the patient population and very serious imprecision . The study did not report on length of hospital stay .
7 . Perioperative oral nutritional supplements versus oral multivitamin and mineral supplement: based on one study with 61 participants, oral supplements compared to a multivitamin and mineral supplement may slightly decrease postoperative complications (low‐quality evidence) . These findings correspond to 135 fewer occurrences per 1000 participants (95% CI 256 fewer to 65 more) . Length of hospital stay may be similar (low‐quality evidence) . We downgraded the quality of evidence of both outcomes for study limitations and imprecision .
Based on few, small and dated studies, with serious methodological limitations, we found limited evidence for a benefit of perioperative nutrition interventions . We rated the quality of evidence as low or very low, which underscores the urgent need for high‐quality research studies to better inform nutritional support interventions for people undergoing surgery for bladder cancer .
Оценить эффекты периоперационного питания у людей, оперируемых по поводу рака мочевого пузыря .
Некоторые люди с распространенным раком мочевого пузыря нуждаются в операции, называемой радикальная цистэктомия, для удаления мочевого пузыря , и есть риск возникновения осложнений после операции .
Некоторые люди, страдающие раком мочевого пузыря, могут иметь трудности с питанием до или после операции, могут терять вес и недоедать . В этом обзоре мы хотели выяснить, приносит ли пользу дополнительное питание в сравнении с обычным питанием .
Доказательства актуальны на 22 февраля 2019 года . Было 8 исследований, проведенных с включением 500 госпитализированных пациентов . Было 7 различных способов питания .
1 . Внутривенное питание в сравнении с пероральным питанием: основываясь на одном исследовании с участием 157 человек, мы обнаружили, что внутривенное питание может увеличить частоту осложнений после операции . Однако, различия в продолжительности пребывания в стационаре, возможно, незначительны или отсутствуют .
2 . Улучшающее иммунитет питание по сравнению со стандартными добавками: улучшающее иммунитет питание содержит в большом количестве нутриенты, которые, как считают, могут улучшать иммунную функцию . Этот вид питания был в одном исследовании с участием 29 человек . Мы нашли, что этот вид питания может уменьшать частоту осложнений в течение 90 дней после операции, но мало влияет на продолжительность госпитализации .
3 . Периоперационная пероральная нутритивная поддержка в сравнении с диетой: основываясь на одном исследовании с участием 28 человек, остается неопределенность в том, что прием пероральных добавок до операции уменьшает частоту осложнений после операции . О продолжительности пребывания в стационаре не сообщали .
4 . Раннее послеоперационное питание в сравнении со стандартной помощью: основываясь на одном исследовании с участием 102 человек, раннее послеоперационное питание может увеличить частоту осложнений после операции, но мы очень не уверены в отношении этого вывода . Длительность госпитализации может быть схожей .
5 . Аминокислоты в сравнении с декстрозой: аминокислоты это строительные блоки белков, а декстроза ‐ это сладкая вода . На основании двух исследований, включающих 104 человека, мы не уверены, может ли быть уменьшена частота осложнений . Длительность госпитализации может быть схожей .
6 . Аминокислоты с разветвленной цепью в сравнении с декстрозой: Основываясь на одном исследовании с участием 19 человек, мы очень не уверены, является ли частота осложнений схожей . О продолжительности пребывания в стационаре не сообщали .
7 . Периоперационные пероральные пищевые добавки в сравнении с мультивитаминными и минеральными добавками: основываясь на одном исследовании с участием 61 человека, пероральные добавки в сравнении с мультивитаминными и минеральными добавками, возможно, слегка снижают частоту послеоперационных осложнений . Длительность госпитализации может быть схожей .
Определенность доказательств в отношении всех исходов в этом обзоре была низкой или очень низкой, подразумевая, что настоящий эффект может очень отличаться или, скорее всего, сильно отличается от того, что мы нашли .
Immuno‐enhancing nutrition may reduce complication rates as may preoperative oral nutrition support and amino acids with dextrose (compared to dextrose alone) but we are uncertain of the latter two findings . Parenteral nutrition when compared to oral nutrition may increase complications (low‐quality evidence) and so may postoperative feeding, although we are very uncertain of the latter finding . Length of hospital stay may not be impacted by any of the nutritional interventions for which we found randomised controlled trial (RCT) evidence .
This review highlights the need for better‐quality research on the perioperative nutritional management of bladder cancer . Further research, particularly RCTs are required to evaluate nutritional interventions pre‐ and postoperatively in the surgical treatment of people diagnosed with muscle‐invasive bladder cancer requiring radical cystectomy . There is a paucity of research evaluating oral and enteral nutritional support in this group using robust research methods . Parenteral nutrition needs to be evaluated further in people who are malnourished following surgery where the feeding regimens are calculated to meet individual requirements . It is also important to consider the risks of refeeding syndrome (a metabolic response to overfeeding after a period of nutritional deprivation) .
Specific comparisons which require further research include:
preoperative nutritional support using oral supplements compared to standard diet;
postoperative oral nutritional support compared to standard diet;
immuno‐enhancing nutrition supplements compared to standard nutrition supplements;
parenteral nutrition requires further evaluation in the postoperative period where participants have a non‐functioning gastrointestinal tract in early compared to late provision of feeding;
patient‐reported outcomes and quality of life measures need to be incorporated into future research as outcome measures;
body composition measurements along with measures of nutritional status need to be included in trials to determine if the interventions are altering nutritional status and body composition .
Postoperative parenteral nutrition compared to oral nutrition alone for the treatment of bladder cancer by radical cystectomy
Participants: people with bladder cancer who have had a radical cystectomy
Settings: University Hospital Bern, Switzerland
Interventions: parenteral nutrition
Control: oral nutrition with Ringer's lactate solution
Anticipated absolute effects* (95% CI)
Risk difference with postoperative parenteral nutrition
198 more per 1000 (35 more to 405 more)
The mean length of hospital stay was 15 .5 days
1 more per 1000 (11 fewer to 200 more)
* The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) .
CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio .
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect . Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different . Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect . Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect .
a Downgraded one level due to study limitations (unclear risk of selection, performance and selective reporting bias) . b Downgraded one level for serious imprecision due to wide confidence intervals that cross assumed threshold of clinical importance . c Downgraded one level for suspected serious imprecision (unable to calculate confidence interval) . d Downgraded two levels for very serious imprecision with very wide confidence interval .
Immunonutrition compared to standard nutritional supplements for the treatment of bladder cancer by radical cystectomy
Participants: people with bladder cancer who have had a radical cystectomy
Settings: University Hospital Kansas, USA
Interventions: immuno‐enhancing nutritional supplement
Control: standard nutritional supplement
Anticipated absolute effects* (95% CI)
Risk with standard nutritional supplements
Risk difference with Immunonutrition
322 fewer per 1000 (429 fewer to 107 more)
The mean length of hospital stay was 6 .1 days
MD 0 .2 days fewer (1 .69 fewer to 2 .09 more)
* The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) .
CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio .
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect . Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different . Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect . Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect .
a Downgraded two levels for very serious imprecision with very wide confidence interval .
Preoperative oral nutritional support compared to normal diet for the treatment of bladder cancer by radical cystectomy
Participants: people with bladder cancer who have had a radical cystectomy
Interventions: oral nutritional supplements
Anticipated absolute effects* (95% CI)
Risk difference with Preoperative oral nutritional support
21 fewer per 1000 (154 fewer to 658 more)
Length of hospital stay – not measured
* The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) .
CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio .
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect . Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different . Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect . Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect .
a Downgraded one level due to study limitations (unclear risk of selection, performance, attrition and selective reporting bias) . b Downgraded two levels for very serious imprecision with very wide confidence interval .
Early postoperative feeding compared to standard management for the treatment of bladder cancer by radical cystectomy
Participants: people with bladder cancer who have had a radical cystectomy
Interventions: early enteral feeding after surgery
Anticipated absolute effects* (95% CI)
Risk difference with early postoperative feeding
83 more per 1000 (89 fewer to 316 more)
The mean length of hospital stay was 9 .7 days
MD 0 .95 days fewer (unable to calculate CI)
19 fewer per 1000 (35 fewer to 72 more)
* The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) .
CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio .
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect . Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different . Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect . Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect .
a Downgraded one level for study limitations (unclear risk of selection and performance bias) . b Downgraded two levels for very serious imprecision with very wide confidence interval . c Downgraded one level for serious imprecision (unable to calculate confidence interval) .
Amino acid solution, alone or in combination with dextrose compared to dextrose solution for the treatment of bladder cancer by radical cystectomy
Participants: people with bladder cancer who have had a radical cystectomy
Interventions: amino acid solutions
Anticipated absolute effects* (95% CI)
Risk difference with amino acid solution, alone or in combination with dextrose
46 fewer per 1000 (136 fewer to 164 more)
The mean length of hospital stay was 32 days
* The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) .
CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio .
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect . Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different . Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect . Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect .
a Downgraded one level due to study limitations (unclear and high risk of selection bias; unclear risk of performance, detection and selective reporting bias) . b Downgraded one level due to serious indirectness related to patient population . c Downgraded two levels due to very serious imprecision with very wide confidence intervals .
Branch chain amino acids compared to dextrose for the treatment of bladder cancer by radical cystectomy
Participants: people with bladder cancer who have had a radical cystectomy
Interventions: branch chain amino acids
Anticipated absolute effects* (95% CI)
Risk difference with branch chain amino acids
Length of hospital stay – not assessed
* The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) .
CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio .
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect . Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different . Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect . Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect .
a Downgraded one level due to study limitations . b Downgraded one level due to serious indirectness related to patient population . c Downgraded two levels due to very serious imprecision with very wide confidence intervals .
Oral nutritional supplements compared to multivitamin and mineral supplement for treatment of bladder cancer by radical cystectomy
Patient or population: treatment of bladder cancer by radical cystectomy
Intervention: oral nutritional supplements
Comparison: multivitamin and mineral supplement
Anticipated absolute effects* (95% CI)
Risk with multivitamin and mineral supplement
Risk difference with oral nutritional supplements
135 fewer per 1000 (265 fewer to 65 more)
The mean length of hospital stay was 8 .9 days
MD 0 .3 days fewer (3 .64 fewer to 3 .04 more)
1 fewer per 1000 (31 fewer to 459 more)
* The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) .
CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio .
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect . Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different . Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect . Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect .
a Downgraded one level for study limitations ( unclear selection, performance and detection bias) . b Downgraded one level due to imprecision and wide confidence intervals .
The worldwide incidence of bladder cancer is reported to be 5 .3 per 100,000 people (age‐standardised rate), and the condition is significantly more prevalent in men (9 .0 per 100,000) than in women (2 .2 per 100,000) ( GLOBOCAN 2012 ) .
When bladder cancer is diagnosed, the majority of people (70% to 75%) have superficial bladder cancer where malignant changes are located on the bladder surface (the urothelium) and limited by the lamina propria (fibrous layer beneath the urothelium) ( de Braud 2002 ; Tobias 2010 ) . The standard treatment for this is transurethral resection of bladder tumour, which involves the removal of the abnormal tissue endoscopically; this may be followed by the instillation of a chemotherapy agent directly into the bladder to reduce the recurrence rate . The most common histological subtype is transitional cell carcinoma . People then require regular follow‐up inspections of the bladder by cystoscopy to detect any recurrence of the tumour .
Where bladder cancer has invaded beyond the lamina propria and into the bladder wall muscle layers, it is termed muscle‐invasive bladder cancer . This may be found at initial presentation or may result from cancer progression in about 10% to 25% of cases previously diagnosed with non‐invasive bladder cancer ( de Braud 2002 ) . The bladder tumour tissue can invade into muscle and in more extensive cases can also infiltrate into adjacent organs such as the prostate, uterus and vagina, or become fixed to the pelvic side wall . Invasive bladder cancer is associated with a greatly increased mortality rate in comparison to non‐invasive bladder cancer . One of the management options is surgery, which in advanced cases is combined with neoadjuvant chemotherapy . The surgical operation is termed a radical (or total) cystectomy (RC); RC may also be indicated for people who have widespread non‐muscle invasive, but high‐grade tumour associated with carcinoma‐in‐situ .
RC is a major surgical procedure consisting of the removal of the bla
Диета После Удаления Мочевого Пузыря
Стол Диета Рецепты Блюд
Центр Снижения Веса Цены
Квашеная Капуста При Диете 5