Palliative Percutaneous Nephrostomy in Recurrent Cervical Cancer: A Retrospective Analysis of 50 Consecutive Cases

Abstract

Cervical cancer is a public health problem in Brazil, with annual incidence rates of 20-40 cases/100,000 women. Most patients with recurrent disease have symptoms from locoregional disease and may develop renal failure. This study aims to evaluate the outcome of patients with recurrent cervical cancer who underwent percutaneous nephrostomy (PN). We reviewed the medical records of 50 such patients who were referred to the Palliative Care Unit of the Brazilian National Cancer Institute from January 2002 to October 2006. Median age was 44 years (range, 26-67 years). Half the patients had improvement in pain or uremic symptoms, and seven (14%) had improved performance status (PS) after the procedure. Thirty patients (60%) had improvement of renal function; median creatinine levels before and after PN were 6.4 and 3.7mg/dL, respectively (P<0.05). Median overall survival after PN was 8.9 weeks (95% confidence interval [CI]: 7.4-10.3). Median survival was 9.9 weeks (95% CI: 8.7-11.0) in 40 patients with baseline PS 1-3 and one week (95% CI: 0.1-1.9) in 10 patients with PS 4 (log rank, P<0.0001). Median survival in patients with and without improvement of renal function after PN was 10.0 weeks (95% CI: 8.6-11.3) and 2.6 weeks (95% CI: 0-11.3), respectively (log rank, P=0.01). Twenty-nine patients (58%) died from renal failure. Complications were mainly urinary tract infection (n=10), catheter loss (n=9), and bleeding (n=1). These data suggest that PN can be of clinical benefit for carefully selected patients with recurrent cervical cancer.

A prognostic model for survival after palliative urinary diversion for malignant ureteric obstruction: a prospective study of 208 patients

“…Also, the stent failure rate is high, with PCN indicated for patients with increased creatinine levels, worsening hydronephrosis, flank pain, infection, or inability to replace the ureteric stent during follow-up [20]. PCN has a morbidity of 44%, mainly due to catheter loss requiring additional intervention and UTI [21]. In our present study, the initial success rate of ureteric stent placement was 27.8%, which was not consistent with rates of 72-92% previously reported [1,22].…”

Nephrostomy Tube Related Pyelonephritis in Patients with Cancer: Epidemiology, Infection Rate and Risk Factors

“…Dienstmann et al reported a UTI incidence of 20% in patients with recurrent cervical cancer who underwent nephrostomy. 5 To our knowledge there has been no established definition of nephrostomy tube related pyelonephritis and only few reports pertaining to nephrostomy related infectious complications. Although several studies have evaluated outcomes and survival duration in patients with cancer who underwent nephrostomy, few studies have assessed the infectious complications in these patients, and used a broad or no definition of infection.…”

Impact of palliative urinary diversion by percutaneous nephrostomy drainage and ureteral stenting among patients with advanced cervical cancer and obstructive uropathy: A prospective cohort

“…This study has considerable strengths. It is among the largest in the literature and unlike many, 4,7,8,14 it is a prospective incident cohort study which recruited consecutive patients from the same population, considered the most appropriate design for considering prognosis 15,16 . Recruitment rate was high at 89.1% of those screened for inclusion and retention was also high, with only 3.4% withdrawing or lost to follow up.…”

“…In order to bypass the ureteric obstruction, urinary diversions have been employed, but more evidence is needed relating to the outcomes of such methods. Percutaneous nephrostomy drainage has been associated with promising results in terms of survival, improved renal function and improvement in pain, uremic symptoms and performance status, but most studies are relatively old, have involved relatively small cohorts and many have been retrospective 4–10 . Although urinary diversion through endoscopic ureteral stenting and percutaneous nephrostomy drainage has offered easily performed procedures that will relieve ureteral obstruction and could prolong survival, an ethical dilemma persists: it has been suggested that quality of life in terms of pain and physical performance after diversion is often poor, so that the benefit the procedures offer to patients is uncertain 4 …”