Urological reconstruction after pelvic oncological surgery: A single institution experience

Tan, Yu Guang; Tan, Grace Hwei Ching; Tan, David; Chia, Claramae Shulyn; Ang, Dun Yong; Teo, Melissa Ching Ching

doi:10.1016/j.asjsur.2016.02.002

Cited by 5 publications

(5 citation statements)

References 29 publications

(35 reference statements)

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“…We did not find any relationship between hydronephrosis and complications after ureteral reconstruction. Guang et al showed that the presence of preoperative hydronephrosis was not a factor in the development of urologic complications [12]. Similarly, in a study by Leapmanet al, three of 30 patients with postoperative urologic complications had preoperative hydronephrosis [4].…”

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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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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“…The long-term outcomes of the Boari flap technique for urological and gynecological disorders have been presented from many institutions [8][9][10] , but only 4 case reports have described the use of this technique for reconstruction after resection of gastrointestinal malignancy [3][4] . Tan et al reported use of this reconstruction procedure for one primary sigmoid colon cancer case and two cases of recurrent colorectal cancer 4 . Tokuoka et al performed single-incision laparoscopic sigmoidectomy followed by Boari flap reconstruction for sigmoid colon cancer without complications 3 .…”

Section: Discussionmentioning

confidence: 99%

“…However, few previous reports have described the application of this technique for combined ureter resection in cases of colorectal cancer. In addition, the long-term prognosis after this technique has not been reported [3][4] . We present a case of rectosigmoid cancer that had infiltrated the lower two-thirds of the right ureter and was managed by performing the Boari flap procedure.…”

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confidence: 97%

Boari Flap Urinary Tract Reconstruction for Rectosigmoid Cancer with Ureteral Invasion: Report of a Case

Kono

Goi

Shimada

et al. 2021

International Surgery

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Introduction: The Boari flap technique is a unique urinary tract reconstruction procedure performed after resection of the urinary tract. However, few previous reports have described the application of this technique to gastrointestinal cancer. Moreover, we have not found any papers describing the long-term prognosis. We report a case of right ureteral tract resection followed by Boari flap reconstruction for rectosigmoid carcinoma, with survival for 108 months without any urological complications. Case presentation: A woman in her 50s was diagnosed with rectosigmoid caner by local physician and referred to our institution. Computed tomography revealed right hydronephrosis due to rectosigmoid cancer invasion at the lower two-thirds of the right ureter. During laparotomy, massive lymphatic infiltration from the primary lesion to right ureter was observed. After primary tumor resection with lower ureter excision, the Boari flap procedure was performed to reconstruct the ureteral deficit. Postoperative course was uneventful, and she was discharged on postoperative day 20. The patient has been followed every 4 months for 9 years with no recurrence or unpleasant symptoms. Discussion: This technique is usually performed to manage specific conditions such as ureteral stenosis caused by ureteral calculi, retroperitoneal fibrosis, and gynecological disorders. This procedure should be reconsidered as a possible option for gastrointestinal malignant cases instead of nephrostomy or cutaneous ureterostomy, given the low rate of complications and high patient satisfaction. Conclusion: The Boari flap technique is particularly useful for bridging between the ureter and bladder in cases of colorectal malignancy with combined resection of the lower urinary tract.

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“…Studies reporting higher rates of surgical failure in radiated fields include a single center study of planned ureteral reconstruction during pelvic cancer surgery. This series revealed that radiated ureteral reconstructions failed nearly 1/3 of the time and the relationship between radiation and failure appeared to be dose dependent (12). Another study evaluated the post-ureteroplasty "trifecta" of (I) freedom from hydronephrosis, (II) freedom from ureteral stent and (III) stable renal function.…”

Section: Radiated Ureteral Repairsmentioning

confidence: 99%

A systematic approach for successful repair of radiated and non-radiated ureteral injuries

Grimes¹,

Schubbe²,

Erickson³

2022

Transl Androl Urol

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Background: Successful ureteral reconstruction is challenging, particularly in radiated fields. We characterize and directly compare surgical outcomes in modern cohorts of radiated and non-radiated patients undergoing ureteral reconstruction utilizing a systematic approach to pre-operative assessment. We hypothesize that radiated patients will undergo more complex ureteral reconstructions and experience higher rates of surgical failure and complications compared to nonradiated patients.Methods: Consecutive cases of ureteral reconstruction for acquired ureteral injury performed by a single surgeon from 2010-2018 were retrospectively reviewed. Clinical data were collected including pre-operative bladder capacity, ureteral injury characteristics, and surgical technique. Ileal ureter and autotransplantation were classified as "complex" ureteral repairs, and surgical success was defined as freedom from surgical revision of the ureteral anastomosis and/or ureteral stenting.Results: There were 47 ureteral reconstructions performed including 17 (36%) radiated patients. Radiated patients had lower pre-operative bladder capacity and were more likely to undergo complex repairs compared to non-radiated patients (35% vs. 7%, P=0.01). Overall surgical success was high (98%) and similar between radiated (94%) and non-radiated groups (100%) at median follow up of 30 months. Clavien grade 3-4 complications occurred in 18% of radiated and 10% of non-radiated patients (P=0.48).Conclusions: Careful pre-operative evaluation and appropriate selection of surgical technique facilitates high and similar success of ureteral reconstruction in radiated and non-radiated patients. Complex ureteral repairs were more common in radiated patients, however the majority of radiated ureteral injuries (65%) were reconstructed without tissue transfer. Radiated patients had lower pre-operative bladder capacities, but similar surgical morbidity, renal function, and persistent urge incontinence compared to non-radiated patients.

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Urological reconstruction after pelvic oncological surgery: A single institution experience

Cited by 5 publications

References 29 publications

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

Boari Flap Urinary Tract Reconstruction for Rectosigmoid Cancer with Ureteral Invasion: Report of a Case

A systematic approach for successful repair of radiated and non-radiated ureteral injuries

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