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Düzgün Ö, Kalın M, Sobay R, Özkan ÖF. Clinical features and surgical outcomes of major urological interventions during cytoreductive surgery and hyperthermic intraperitoneal chemotheraphy. Ther Adv Urol 2020; 12:1756287220975923. [PMID: 33354230 PMCID: PMC7734548 DOI: 10.1177/1756287220975923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 11/03/2020] [Indexed: 12/29/2022] Open
Abstract
Background: Urinary system resections and reconstructions are needed in peritoneal carcinomatosis due to abdominal malignancies. The effect of hyperthermic intraperitoneal chemotherapy on these urological procedures after reconstruction remains uncertain. The aim of the study is to evaluate major urological interventions during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in complex abdominal malignancies with peritoneal carcinomatosis. Methods: Forty-four cases underwent surgical intervention related to the urinary system among 208 cases who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy because of peritoneal carcinomatosis. Urinary system procedures performed in these patients (radical-partial cystectomy, partial ureter resection ureteroneocystostomy, ureteroureterostomy, nephrectomy) were evaluated in terms of postoperative morbidity–mortality and survival. Results: Urinary system resections were performed during cytoreductive surgery in a total of 44 cases. The mean age was 54 years (20–73). Patients were diagnosed with peritoneal carcinomatosis due to colorectal cancer in 21 (47.8%), ovarian cancer in nine (20.4%), sarcomatosis in five (11.4%), cervical cancer in four (9%) and other cancers (mesothelioma, uterus, breast, gastric) in five (11.4%) cases. Total nephrectomy was performed in three cases and partial nephrectomy in one case. Cystectomy was performed in 21 cases; 16 of these were partial and five were total cystectomies. Ureteroureterocystostomy with double J was performed in four cases and ureteroneocystostomy in 12 cases. While Clavian–Dindo grade 3–4 complications were seen in nine cases (20.4%), three cases (6.8%) became exitus during the first 30-day follow-up. Conclusions: Although urinary system involvements have been regarded as inoperable in the past, we think that with adequate experience radical urinary interventions performed in suitable patients can be carried out with acceptable morbidity and mortality as seen in our series.
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Affiliation(s)
- Özgül Düzgün
- Department of General Surgery, Health Sciences University, Umraniye Research and Education Hospital, Istanbul, Turkey
| | - Murat Kalın
- Department of General Surgery, Health Sciences University,Umraniye Research and Education Hospital, İstanbul,Turkey
| | - Resul Sobay
- Department of Urology, Health Sciences University, Umraniye Research and Education Hospital, Istanbul, Turkey
| | - Ömer Faruk Özkan
- Department of General Surgery, Health Sciences University, Umraniye Research and Education Hospital, Istanbul, Turkey
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3D laparoscopy as a tertiary cytoreductive (TCR) surgery in infiltrating ureter recurrent epithelial ovarian cancer - case report and a mini-review of the literature. MENOPAUSE REVIEW 2019; 17:185-188. [PMID: 30766467 PMCID: PMC6372846 DOI: 10.5114/pm.2018.81745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 11/22/2018] [Indexed: 11/17/2022]
Abstract
The paper describes a case of a 61-year-old woman with recurrent epithelial ovarian cancer infiltrating the ureter treated with 3D laparoscopy as a tertiary cytoreductive surgery (TCR). In addition, a mini-review of the literature concerning TCR is presented.
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Trujillo CG, Domínguez C, Robledo D, Caicedo JI, Bravo-Balado A, Cataño JG, Cortés N, Parra L, Riaño W, Londoño-Schimmer E, Otero J, Herrera G, Arias F, Plata M. Urological approach for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a clinical care center. Acta Chir Belg 2018; 118:348-353. [PMID: 29475412 DOI: 10.1080/00015458.2018.1436797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is associated with significant manipulation of the urinary tract (UT). We aim to describe the urological events and their management in patients who underwent CRS-HIPEC. METHODS Clinical records of patients who underwent treatment between 2007 and 2015 were reviewed. Urological events and their multidisciplinary management were analyzed. Descriptive statistics were calculated. RESULTS A total of 103 patients were included. Mean age was 51 years (SD ± 11.8). Mean peritoneal cancer index (PCI) was 20.4 (SD ± 10.1). Primary tumors included appendicular (64%), gynecological (16%), colorectal (10%), and peritoneal mesotheliomas (9%). Ninety-three percent of patients had bilateral ureteral catheters inserted prior to surgery, without complications. Intraoperative UT injuries occurred in 7% of patients. In 5% of patients, tumor invasion of the bladder was evident at surgery and partial resection and primary repair of the bladder wall was performed. Urological complications included urinary tract infection (UTI) (21%) acute post-renal failure (4%), urinary fistulae (4%), and acute urinary retention (AUR) (1%). CONCLUSIONS In our study, intraoperative UT events and postoperative complications, although not neglectable, were infrequent. Due to the high complexity of these cases, a multidisciplinary approach is mandatory. However, randomized clinical trials are necessary to clarify current data on the need and efficacy of prophylactic ureteral catheterization in patients undergoing CRS-HIPEC.
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Affiliation(s)
- Carlos Gustavo Trujillo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá, Colombia
| | - Cristina Domínguez
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá, Colombia
| | - Daniela Robledo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá, Colombia
| | - Juan Ignacio Caicedo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá, Colombia
| | - Alejandra Bravo-Balado
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá, Colombia
| | - Juan Guillermo Cataño
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá, Colombia
| | - Natalia Cortés
- Department of Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Lina Parra
- Department of Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Wilson Riaño
- Department of Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Eduardo Londoño-Schimmer
- Department of Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Clinical Care Center for Peritoneal Neoplasms, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Jorge Otero
- Clinical Care Center for Peritoneal Neoplasms, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Department of Oncology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Gabriel Herrera
- Department of Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Clinical Care Center for Peritoneal Neoplasms, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Fernando Arias
- Department of Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Clinical Care Center for Peritoneal Neoplasms, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Mauricio Plata
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá, Colombia
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