Presentation Authors: Janet Baack Kukreja*, Denver, CO, Neema Navai, Jieli Li, Qing H. Meng, Mohamed Seif, Marisa Lozano, Xuemei Wang, Hyunsoo Hwang, Ashish Kamat, O. Lenaine Westney, Colin Dinney, Houston, TX
Introduction: Patients undergoing major operations often become catabolic and have muscle break down. Patients undergoing cystectomy fall into this category and the catabolism postoperatively frequently leads to poor outcomes. We sought to detail the testosterone levels in patients preoperatively (preop) and postoperatively (POD) to study the potential for future intervention with anabolic steroids and which patients might benefit the most from such an intervention.
Methods: Patients were prospectively enrolled in the study. Blood was collected preop, POD1, POD3 and POD14. Testosterone was analyzed with electrochemiluminescence immunoassay on Roche Cobas 8000 in the clinical laboratory. A high affinity monoclonal antibody specifically directed against testosterone was used. Testosterone was measured in ng/dl. Testosterone < 300 ng/dl was considered hypogonadal. Poor recovery was considered a complication greater than Clavien grade 2 or a readmission. Frailty was determined by preoperative G8 geriatric assessment. Chi-squared and logistic regression were used where appropriate.
Results: Median age was 70.5. There were 40 males and 6 females. In males: the mean preop testosterone was 517, POD1-280, POD3-234, POD14-372. In females: the mean preop testosterone was 14, POD1-25, POD3-21, POD14-14. Of the males, 22% were hypogonadal preop, 61% POD1, 68% on POD3, 39% on POD14. Higher testosterone level preop, higher POD14 and change in testosterone level as a continuous variable were not associated with a greater chance of poor or ideal recovery (p=0.12, p=0.13, and p=0.07, respectively. Of those who were considered frail (n=7), 70% were hypogonadal by POD 3 (p < 0.05). Patients with preoperative hypogonadism were significantly associated with poor recovery (p < 0.05).
Conclusions: In men undergoing cystectomy, preoperative frailty as well as hypogonadism are significant predictors of poor recovery. Underlying catabolism from surgery may be able to be predicted preoperatively and be proactively treated in order to attain ideal recovery for patients undergoing cystectomy. Further exploration is warranted in improving surgical outcomes with anabolic steroid supplementation in those at highest risk of poor recovery.
Source of Funding: The University of Texas MD Anderson SPORE in Genitourinary Cancer