Impact of Preoperative CT-Diagnosed Sarcopenic Obesity on Outcomes After Radical Cystectomy for Bladder Cancer

To evaluate the impact of body composition parameters, including specifically sarcopenic obesity (SO), on postoperative and oncological outcomes in patients undergoing radical cystectomy (RC) for bladder cancer, thereby addressing a paucity of data in this setting.

A retrospective observational study was conducted in patients who underwent RC. Preoperative CT scans were analyzed using semi-automatic segmentation software to assess body composition parameters, with measurements of adipose and muscle tissue obtained at the level of the L3 vertebra.

A total of 249 patients were included, of whom 127 (52.5%) met the criteria for sarcopenia, 53 (21.3%) for obesity, and 14 (5.6%) for SO. Multivariate analysis identified previous abdominal surgery (OR 2.56, 95% CI 1.24-5.23, p = 0.011), total serum protein level (OR 0.57, 95% CI 0.36-0.88, p = 0.013), and SO (OR 7.01, 95% CI 1.06-37.05, p = 0.045) as independent predictors of 90-day postoperative complications. Patients with SO experienced significantly higher rates of abdominal wall complications (p = 0.03). However, in multivariate analyses, SO was not associated with overall survival (despite a p value of 0.04 at univariate analysis), cancer-specific survival, or progression-free survival.

Preoperative CT-based assessment of body composition is a valuable tool in the surgical evaluation of patients undergoing RC. SO appears to be an independent predictor of short-term postoperative complications and should be considered when planning prehabilitation strategies.