The role of nutritional assessment and support in patients with bladder carcinoma undergoing radical cystectomy is controversial. Morphometric, visceral protein and cell-mediated immune statuses were measured in 33 patients with bladder cancer treated by radical cystectomy. Malnourished patients had greater operative morbidity, operative mortality and days of intensive care than their nutritionally normal counterparts. Kaplan-Meier survival plots showed a tendency to early death of disease in the malnourished patients with convergence of survival rates after 36 months. Of the malnourished patients 7 had extensive nutritional support, and 6 had no parenteral and minimal enteral or oral support. Operative morbidity and mortality rates were higher in the nutritionally supported than in the unsupported groups. Nutritional support in the immediate perioperative period probably does little to alter operative complications.