Not just about weight: Identifying hidden nutritional vulnerability after radical cystectomy.

Energy and protein adequacy was low during the first postoperative week despite stable body weight.

• Study involved 25 ERAS-managed patients undergoing radical cystectomy in a prospective observational design.
• Body weight remained stable during the first postoperative week, likely influenced by fluid retention.
• Low energy and protein adequacy occurred concurrently with the stable weight readings, suggesting weight was masking nutritional deficits.

Significant weight loss emerged by postoperative day 14 and continued to increase by day 30.

• Weight loss at day 14 was -2.3% (p < 0.001).
• Weight loss at day 30 was -5.3% (p < 0.001).
• Weight loss occurred despite dietetic follow-up and improvements in dietary intake over time.

Patients requiring nasogastric decompression experienced greater weight loss than those without nasogastric decompression.

• Weight loss was -7.2% in patients requiring nasogastric decompression versus -3.9% in those without (p = 0.004).
• This difference suggests an association between nasogastric decompression and nutritional deterioration.
• The finding highlights nasogastric decompression as a marker of patients at higher nutritional risk.

Early postoperative weight trajectory alone is not a reliable indicator of nutritional status after radical cystectomy.

• Stable weight in the first postoperative week was likely influenced by fluid retention rather than nutritional adequacy.
• The authors conclude that evaluating dietary intake, nutritional symptoms, and body composition including fluid balance is likely required for optimal clinical decision-making.
• Individualized, symptom-responsive strategies including consideration of supplemental nutrition in patients with persistent intolerance are recommended.

Dietary intake patterns and their adequacy in patients undergoing radical cystectomy remain poorly defined prior to this study.

• Patients undergoing radical cystectomy face substantial nutritional challenges according to the authors.
• The study was designed as a prospective observational study with 25 patients managed under an ERAS (Enhanced Recovery After Surgery) protocol.
• The study specifically aimed to characterize energy and protein intake adequacy in the perioperative period.