Effect of a concomitant urologic procedure on outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Lyon, Timothy D.; Turner, Robert; Nikonow, Tara; Wang, Li; Uy, Jamie; Ramalingam, Lekshmi; Holtzman, Matthew P.; Pingpank, James F.; Bartlett, David L.; Davies, Ben

doi:10.1002/jso.24115

Cited by 11 publications

(12 citation statements)

References 17 publications

(36 reference statements)

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“…Similar to a recent report, we found that having a concomitant URR during CRS-HIPEC was associated with a longer operation time. However, unlike the Pittsburgh group [11] , we did not find a difference in length of ICU stay or hospital stay ( p = 0.51 and 0.094 respectively). This may be due to the relatively small number of URR procedures in our CRS-HIPEC cohort.…”

Section: Discussioncontrasting

confidence: 90%

“…In addition, there was no difference in perioperative complication rate ( p = 0.28), rate of major complications ( p = 0.42), or blood loss ( p = 0.62) during the combined procedure. Few western centres have reported increase in major complications amongst patients who undergo URR during CRS-HIPEC [11] , [12] , but the difference has been postulated to be due to an increase in urinary-tract specific complications related to the URR themselves [11] .…”

Section: Discussionmentioning

confidence: 99%

“…Urological resections and reconstruction (URR) are occasionally required during the CRS, due to disease involvement especially in patients with heavy pelvic disease volume, or secondary to inadvertent injury. Urological involvement during CRS and HIPEC has been reported in 7%–20% of published reports [5] , [6] , [7] , [8] , [9] , [10] , [11] , although the impact on postoperative outcomes and long-term survival remains inconclusive. Studies have alternatively reported no differences in morbidity, operation time or overall survival (OS) [9] , increased operation time without effect on morbidity or survival [8] , increased risk of severe morbidity without an effect on survival [12] and increased operation time and risk of major complications, but with no effect on OS [11] .…”

Section: Introductionmentioning

confidence: 99%

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The impact of urological resection and reconstruction on patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)

Tan

Shannon

Chia

et al. 2018

Asian Journal of Urology

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ObjectiveCytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are increasingly being used to treat peritoneal malignancies. Urological resections and reconstruction (URR) are occasionally performed during the surgery. We aim to evaluate the impact of these procedures on peri-operative outcomes of CRS and HIPEC patients.MethodsA retrospective review of a prospectively maintained database of all patients who underwent CRS-HIPEC from April 2001 to February 2016 was performed. Outcomes between patients who had surgery involving, and not involving URR were compared. Primary outcomes were the rate of major complications and the duration of stay in the intensive care unit (ICU) and hospital. Secondary outcomes were that of overall survival (OS) and prognostic factors that would indicate a need for URR.ResultsA total of 214 CRS-HIPEC were performed, 21 of which involved a URR. Baseline clinical characteristics did not vary between the groups (URR vs. No URR). Urological resections comprised of 52% bladder resections, 24% ureteric resections, and 24% involving both bladder and ureteric resections. All bladder defects were closed primarily while ureteric reconstructions consisted of two end-to-end anastomoses, one ureto-uretostomy, five direct implantations into the bladder and three boari flaps. URR were more frequently required in patients with colorectal peritoneal disease (p = 0.029), but was not associated with previous pelvic surgery (76% vs. 54%, p = 0.065). Patients with URR did not suffer more serious complications (14% vs. 24%, p = 0.42). ICU (2.2 days vs. 1.4 days, p = 0.51) and hospital stays (18 days vs. 25 days, p = 0.094) were not significantly affected. Undergoing a URR did not affect OS (p = 0.99), but was associated with increased operation time (570 min vs. 490 min, p = 0.046).ConclusionWhile concomitant URR were associated with an increase in operation time, there were no significant differences in postoperative complications or OS. Patients with colorectal peritoneal metastases are more likely to require a URR compared to other primary tumours, and needs to be considered during pre-operative planning.

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Section: Discussioncontrasting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The impact of urological resection and reconstruction on patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)

Tan

Shannon

Chia

et al. 2018

Asian Journal of Urology

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“…However, we did not find any studies on the effect of isolated ureteral reconstruction on hospital stay. In a study by Lyon et al, the duration of hospitalization was significantly longer in patients that underwent a urological procedure (cystectomy, nephrectomy, ureteral repair, ureteral reconstruction, seminal gland resection) [8]. In another study conducted by Tan et al, hospital stay was found to be longer in patients that underwent a urological intervention [9].…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown that the possibility of postoperative complications is increased in CRC-HIPEC cases undergoing a urinary system intervention. Lyon et al reported that the rate of complications was significantly higher following urinary system interventions compared to cases that did not undergo such an intervention [8]. Early complications include anastomotic leakage, obstruction, fistula, and pyelonephritis while obstruction and urinary tract stones are usually seen as late complications.…”

Section: Discussionmentioning

confidence: 99%

The outcomes of isolated ureteral resection and reconstruction in non-urologic cancer patients who underwent cytoreductive surgery (CRC) and hyperthermic intraperitoneal chemotherapy (HIPEC)

et al. 2019

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BackgroundUrinary system resections are performed during the cytoreductive surgery with hypertermic intraperitoneal chemotherapy (CRS-HIPEC). However, isolated ureter resection and reconstruction results are uncertain. The aim of this study was to evaluate the postoperative outcomes of isolated ureteral resection and reconstructions in patients who underwent CRC and HIPEC procedure.MethodsA total of 257 patients that underwent CRC and HIPEC between 2015 and 2017 in the Department of Surgical Oncology, Faculty of Medicine, Ankara University, were retrospectively analyzed. Twenty patients that had undergone isolated ureteral resection and reconstruction were included in the study. Predisposing factors were investigated in patients who developed postoperative complications.ResultsThe mean age of the patients was 55.1 years. The mean follow-up time of all the patients was 11.6 months. Postoperative mortality occurred in two patients. The mean PCI score was 13.9. Postoperative urologic complications were observed in eight patients after ureter reconstruction. There was no statistically significant difference between the groups in terms of reconstruction techniques and postoperative complications (P = 302). There was no correlation between age (P = 0.571) and gender (P = 0.161) with complications. CRS-HIPEC was performed mostly due to gynecologic malignancy. However, there was no correlation between the primary cancer diagnosis and the development of complications (P = 0.514). The hospital stay duration was higher in the group with complications (16.3 vs 8.8 days, P = 0.208).ConclusionsUreteral resections and reconstructions can be performed for R0/1 resections in CRS-HIPEC operations. It leads to an increase in hospital stay. But there is no significant difference in the development of complications. In the management of complications, conservative approach was sufficient.

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Management of Complications of CRS and HIPEC

Bhatt

Mehta²

2017

Management of Peritoneal Metastases- Cytoreductive Surgery, HIPEC and Beyond

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Effect of a concomitant urologic procedure on outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Abstract: Urologic surgery at the time of CRS-HIPEC is associated with longer operative times, length of stay and increased risk of major complications, but not with decreased overall survival. J. Surg. Oncol. 2016;113:218-222. © 2016 Wiley Periodicals, Inc.

Cited by 11 publications

References 17 publications

The impact of urological resection and reconstruction on patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)

The impact of urological resection and reconstruction on patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)

The outcomes of isolated ureteral resection and reconstruction in non-urologic cancer patients who underwent cytoreductive surgery (CRC) and hyperthermic intraperitoneal chemotherapy (HIPEC)

Management of Complications of CRS and HIPEC

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