Platinum Priority – Bladder Cancer Editorial by Massimo Maffezzini on pp. 483–485 of this issue Parenteral Nutrition Does Not Improve Postoperative Recovery from Radical Cystectomy: Results of a Prospective Randomised Trial Beat Roth, Fre ´de ´ric D. Birkha ¨user, Pascal Zehnder, George N. Thalmann, Mirjam Huwyler, Fiona C. Burkhard, Urs E. Studer * Department of Urology, University of Bern, Bern, Switzerland EUROPEAN UROLOGY 63 (2013) 475–482 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted May 28, 2012 Published online ahead of print on June 5, 2012 Keywords: Bladder cancer Cystectomy Parenteral nutrition Postoperative complications Infections Abstract Background: After radical cystectomy, patients are in a catabolic state because of postoperative stress response, extensive wound healing, and ileus. Objective: To evaluate whether recovery can be improved with total parenteral nutri- tion (TPN) in patients following extended pelvic lymph node dissection (ePLND), cystectomy, and urinary diversion (UD). Design, setting, and participants: We conducted a prospective, randomised, single- centre study of 157 consecutive cystectomy patients. Intervention: Seventy-four patients (group A) received TPN during the first 5 postoper- ative days, with additional oral intake ad libitum. Eighty-three patients (group B) received oral nutrition alone. Outcome measurements and statistical analysis: The primary outcome was the occurrence of postoperative complications. Secondary outcomes were time to recov- ery of bowel function, biochemical nutritional (serum albumin, serum prealbumin, serum total protein) and inflammatory (C-reactive protein) parameters, length of hospital stay, and costs attributed to the TPN. The Pearson x 2 test was used for dichotomous variables; the Wilcoxon rank sum test was used for continuous variables. Results and limitations: Postoperative complications occurred in 51 patients (69%) in group A and in 41 patients (49%) in group B ( p = 0.013), a difference resulting from group A having more infectious complications than group B (32% vs 11%; p = 0.001). Serum prealbumin and serum total protein were significantly lower in group B on postoperative day 7 but not on postoperative day 12. Time to gastrointestinal recovery and length of hospital stay did not differ between the two groups. The costs for TPN were s614 per patient. A potential limitation is the use of a glucose-based parenteral nutrition without lipids. Conclusions: Postoperative TPN is associated with a higher incidence of complications, mainly infections, and higher costs following ePLND, cystectomy, and UD versus oral nutrition alone. # 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author. Department of Urology, University Hospital Bern, CH-3010 Bern, Switzerland. Tel. +41 31 632 36 41; Fax: +41 31 632 21 80. E-mail address: urology.berne@insel.ch (U.E. Studer). 0302-2838/$ – see back matter # 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.eururo.2012.05.052