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Ahmad MU, Siddiqui S, Ashraf FA, Iqbal R, Ehsanullah SAM, AlFayadh A, Siddiqui MRS, Khan MS, Furrer MA. Retrograde Ureteral Stents Versus Percutaneous Nephrostomy in the Management of Malignant Ureteral Obstruction: A Systematic Review and Meta-Analysis. Urology 2024; 192:158-167. [PMID: 38830555 DOI: 10.1016/j.urology.2024.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE To evaluate outcomes in cancer patients with ureteral obstruction by comparison of retrograde stenting and percutaneous nephrostomy techniques. METHODS Systematic review of all studies up to October 2023. Studies were identified from all major databases including MEDLINE, Cochrane, and EMBASE. All comparative studies between retrograde stenting and percutaneous nephrostomy were searched; studies with paediatric populations were excluded. Primary outcomes were procedure and intervention failure rates; secondary outcomes were infection, blockage, displacement, and unplanned exchange rates along with procedure time and length of stay. RESULTS Eighteen studies with 1228 patients contributed to the summative outcome. Percutaneous nephrostomy was statistically superior to retrograde stenting for procedure failure rate (P <.00001) and intervention failure rate (P =.0004). Retrograde stenting was statistically superior to percutaneous nephrostomy for displacement rates (P = .003), procedure time (P <.00001), and length of stay (P <.00001). Retrograde stenting showed no difference to percutaneous nephrostomy for infection rates (P = .94), blockage rates (P = .93), unplanned exchange rates (P = .48), CONCLUSION: There is no absolute superiority for retrograde stenting or percutaneous nephrostomy for malignant ureteral obstruction. Both techniques have their advantages and disadvantages, with some comparable outcomes; patients are key when selecting the best technique. Larger studies are required to assess the outcomes of both techniques.
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Affiliation(s)
- Mohammad Usman Ahmad
- Department of Urology, Manchester University Teaching Hospitals NHS Foundation Trust, Manchester, United Kingdom.
| | - Saad Siddiqui
- Department of Urology, Royal Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Faisal Amir Ashraf
- Department of Radiology, University Hospitals North Midlands NHS Trust, Stoke-On-Trent, United Kingdom
| | - Rizwan Iqbal
- Department of Urology, NHS Forth Valley, Falkirk, United Kingdom
| | | | - Ayat AlFayadh
- Department of Surgery, South Tyneside and Sunderland Hospitals NHS Foundation Trust, Sunderland, United Kingdom
| | | | - Muhammad Shamim Khan
- Department of Urology, The Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Marc Alain Furrer
- Department of Urology, The Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Urology, Solothurner Spitäler AG, Kantonsspital Olten, and Bürgerspital Solothurn, Switzerland; Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Gebreselassie KH, Adamu TA, Beyene AD. Ureteral stenting in patients with locally advanced cervical cancer: Predictors of low success rate. Gynecol Oncol Rep 2024; 55:101491. [PMID: 39286433 PMCID: PMC11402550 DOI: 10.1016/j.gore.2024.101491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 08/16/2024] [Accepted: 08/20/2024] [Indexed: 09/19/2024] Open
Abstract
Objective Cervical cancer is the leading gynecologic malignancy in Ethiopia. The diagnosis is often delayed and many patients present with locally advanced disease. Involvement of the ureters with or without the development of hydroureteronephrosis is a common finding. Ureteral stent placement is a modality utilized to relieve an established obstruction (therapeutic) or to prevent its early occurrence (prophylactic). However, the procedure may not be successful in all patients. The objective of this study is to assess the factors associated with low success rate of ureteral stenting in these patients with locally advanced disease. Methods This is a hospital based cross-sectional study of patients diagnosed with locally advanced cervical cancer for whom a retrograde ureteral stent placement is attempted from January 2019 to March 2020. Data of 175 patients were retrieved by a retrospective chart review and analyzed for factors associated with low procedural success. Results Socio-demographic data were similar between patients regardless of procedural success. The overall success rate of stenting was 54.2 %. In the prophylactic group (with no hydronephrosis and normal creatinine) success rate was 94 % and in the therapeutic group 42.6 %. Logistic regression analysis showed that bilateral hydronephrosis and increased serum creatinine were indicators of significant ureteral obstruction and were predictors of stent placement failure. Conclusion Increased serum creatinine and presence of hydronephrosis are risk factors for failed ureteral stenting. For these patients, other options of urinary diversion such as percutaneous nephrostomy should be considered from the outset.
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Affiliation(s)
| | - Tadele Aweke Adamu
- Urology Unit, Department of Surgery, College of Medicine, Jimma University, Jimma, Ethiopia
| | - Andualem Deneke Beyene
- Urology Unit, Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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Shah M, Blest F, Blackmur J, Laird A, Dawson S, Aning J. Malignant upper urinary tract obstruction in cancer patients: A systematic review. BJUI COMPASS 2024; 5:405-416. [PMID: 38751956 PMCID: PMC11090775 DOI: 10.1002/bco2.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/05/2024] [Accepted: 02/04/2024] [Indexed: 05/18/2024] Open
Abstract
Objective To systematically summarise the current clinical evidence for de novo malignant upper urinary tract obstruction treatment with a focus on standards of reporting, patient outcomes and future research needs. Methods This review protocol was published via PROSPERO (CRD42022341588). OVID MEDLINE (R), EMBASE, Cochrane Central Register of Controlled Trials-CENTRAL were searched up to June 2022 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Prospective and retrospective studies were included. Results Of 941 articles identified, 82 with 8796 patients were eligible for inclusion.Most studies in the published literature are retrospective and investigate heterogenous malignancies. Percutaneous nephrostomy and ureteric stenting are the most studied interventions. Few studies describe the outcomes from no intervention or investigate patient perspectives. Overall reported median survival after intervention was around 11.7 months. A lack of standardised reporting of outcomes was evident. Conclusions Malignant upper urinary tract obstruction is an important clinical condition affecting patients globally. Overall survival after intervention appears poor however the current evidence base has significant limitations due to studies of low methodological quality and the lack of a standardised framework for reporting outcomes.We have provided a pragmatic framework for future studies based on the review to ensure a uniform methodology is utilised moving forward.
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Affiliation(s)
| | | | - James Blackmur
- Department of UrologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
- Early Cancer InstituteUniversity of CambridgeCambridgeUK
| | - Alexander Laird
- Department of Urology, Western General HospitalEdinburghUK
- Institute of Genetics and CancerThe University of EdinburghEdinburghUK
| | | | - Jonathan Aning
- Bristol Urological Institute, Southmead HospitalNorth Bristol TrustBristolUK
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
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Alarcón-Barrios S, Luvián-Morales J, Castro-Eguiluz D, Delgadillo-González M, Lezcano-Velázquez BO, Arango-Bravo EA, Flores-Cisneros L, Aguiar Rosas S, Cetina-Pérez L. Chemoradiotherapy treatment with gemcitabine improves renal function in locally advanced cervical cancer patients with renal dysfunction. Curr Probl Cancer 2024; 48:101041. [PMID: 37988902 DOI: 10.1016/j.currproblcancer.2023.101041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/23/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Cervical cancer (CC) in Mexico is diagnosed mainly in locally advanced (LACC) and advanced (ACC) stages, where ureteral obstruction is more frequent. The standard treatment for this population is concurrent chemoradiotherapy (CCRT) with cisplatin, which is nephrotoxic and could lead to further deterioration of renal function in LACC patients with renal function decline. We aimed to evaluate the effect of CCRT with Gemcitabine on renal function in LACC patients. METHODS This retrospective study included LACC patients treated with CCRT with Gemcitabine as a radiosensitizer from February 2003 to December 2018. Data were collected from medical archives and electronic records. We assessed renal function before and after CCRT treatment and analyzed the patient's response to treatment and survival. RESULTS 351 LACC patients treated were included and stratified into two groups: 198 with Glomerular Filtration Rate (GFR) ≥60ml/min (group A) and 153 with GFR<60ml/min (group B). An improvement in GFR was observed after CCRT in patients in group B, from 33 ml/min to 57.5 ml/min (p<0.001). Complete response was observed in 64.1% of patients in Group A and 43.8% in Group B (p<0.0001). Factors associated with increased risk of death included having a GFR of 15-29 ml/min (HR: 2.17; 1.08-4.35), having GFR<15 ml/min (HR: 3.08; 1.63-5.79), and receiving Boost treatment (HR: 2.09; 1.18-3.69). On the other hand, receiving brachytherapy is a positive predictor for OS (HR:0.51; 0.31-0.84). CONCLUSION CCRT with gemcitabine is an appropriate treatment option for patients diagnosed with LACC who present impaired renal function due to the disease's obstructive nature or other comorbidities.
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Affiliation(s)
- Silvia Alarcón-Barrios
- Programa de Maestría y Doctorado en Ciencias de la Salud, Universidad Nacional Autónoma de México, Mexico City, México; MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Pain Clinic, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Julissa Luvián-Morales
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Denisse Castro-Eguiluz
- Consejo Nacional de Humanidades, Ciencia y Tecnología (CONAHCyT) Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Merari Delgadillo-González
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Brenda Olivia Lezcano-Velázquez
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Pain Clinic, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Eder Alexandro Arango-Bravo
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Sebastián Aguiar Rosas
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Pain Clinic, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Lucely Cetina-Pérez
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico.
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5
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Li J, Cao H, Peng K, Chen R, Sun X. Hydronephrosis in patients with cervical cancer: An improved stent-change therapy for ureteral obstruction Stent-change for ureteral obstruction in cervical cancer. Eur J Obstet Gynecol Reprod Biol 2023; 283:49-53. [PMID: 36773470 DOI: 10.1016/j.ejogrb.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 12/12/2022] [Accepted: 01/22/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Ureteral stent replacement is a routine treatment for hydronephrosis in patients with cervical cancer. We developed an improved ureteral stent-change operation for hydronephrosis in cervical cancer patients and compared its outcomes with traditional stent change procedures. STUDY DESIGN Clinical data of hydronephrosis in cervical cancer patients who were admitted to our hospital from August 2014 to October 2019 were analyzed. We retrospectively reviewed 131 cervical cancer patients, out of which 43 cases included patients in the improved operation group, whereas 88 patients with hydronephrosis followed the traditional ureteral stent-change operation for ureteral obstruction. The outcomes of the two procedures were compared using the propensity score matching method. RESULTS As opposed to the traditional ureteral stent change strategy, the patients in the improved group required shorter operation time (p = 0.001) and higher success rate (p = 0.004). The FIGO stage (p = 0.046), the level of ureteral obstruction (p = 0.027), radiotherapy history (p = 0.01), stent replacement times (≤2times or > 2times) (p = 0.001), and serum creatinine level (≤200 μmol/L or > 200 μmol/L) (p < 0.001) were significantly different between the two groups before propensity score matching. Propensity score matching analysis was used to eliminate the clinical differences of 43 patients in the traditional group; however, the span of visual hematuria during the surgical complications was not included (p = 0.026) in the results. CONCLUSION An improved ureteral stent change operation is an advanced treatment option for cervical cancer patients suffering from hydronephrosis. In contrast to traditional ureteral stent change techniques, our developed strategy lowers complications such as visual hematuria but improves the success.
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Affiliation(s)
- Jie Li
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Haiming Cao
- Department of Andrology, the Reproductive Medicine Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China.
| | - Kang Peng
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Renfu Chen
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiaolei Sun
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, China.
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Gadelkareem RA, Abdelraouf AM, El-Taher AM, Ahmed AI. Acute kidney injury due to bilateral malignant ureteral obstruction: Is there an optimal mode of drainage? World J Nephrol 2022; 11:146-163. [PMID: 36530794 PMCID: PMC9752243 DOI: 10.5527/wjn.v11.i6.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/29/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022] Open
Abstract
There is a well-known relationship between malignancy and impairment of kidney functions, either in the form of acute kidney injury or chronic kidney disease. In the former, however, bilateral malignant ureteral obstruction is a surgically correctable factor of this complex pathology. It warrants urgent drainage of the kidneys in emergency settings. However, there are multiple controversies and debates about the optimal mode of drainage of the bilaterally obstructed kidneys in these patients. This review addressed most of the concerns and provided a comprehensive presentation of this topic from the recent literature. Also, we provided different perspectives on the management of the bilateral obstructed kidneys due to malignancy. Despite the frequent trials for improving the success rates and functions of ureteral stents, placement of a percutaneous nephrostomy tube remains the most recommended tool of drainage due to bilateral ureteral obstruction, especially in patients with advanced malignancy. However, the disturbance of the quality of life of those patients remains a major unresolved concern. Beside the unfavorable prognostic potential of the underlying malignancy and the various risk stratification models that have been proposed, the response of the kidney to initial drainage can be anticipated and evaluated by multiple renal prognostic factors, including increased urine output, serum creatinine trajectory, and time-to-nadir serum creatinine after drainage.
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Affiliation(s)
- Rabea Ahmed Gadelkareem
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Assiut, Egypt
| | - Ahmed Mahmoud Abdelraouf
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Assiut, Egypt
| | - Ahmed Mohammed El-Taher
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Assiut, Egypt
| | - Abdelfattah Ibrahim Ahmed
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Assiut, Egypt
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Zhang KP, Zhang Y, Chao M. Which is the best way for patients with ureteral obstruction? Percutaneous nephrostomy versus double J stenting. Medicine (Baltimore) 2022; 101:e31194. [PMID: 36397363 PMCID: PMC9666138 DOI: 10.1097/md.0000000000031194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Percutaneous nephrostomy (PCN) and Double J stenting (DJS) are the 2 main treatment options of ureteral obstruction. We evaluate which of these 2 methods is superior concerning the course of procedure, postoperative complication and quality of life. METHODS A detailed review of electronic databases including PubMed, Embase, Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure up to February 21st, 2021 was searched. Continuous data were evaluated using mean difference (MD) with 95% confidence interval (CI), while nominal data were analyzed by risk ratio (RR) with 95% CI. Meanwhile, we performed the subgroup analysis based on study design, disease type, sample size, sepsis, DJ diameter, nephrostomy diameter, anesthesia type and guidance under X-ray or ultrasound. RESULTS There were 18 previous studies included in current study. As a result, we found that there were significant differences in fluoroscopy time (MD = 0.31; 95% CI, 0.14-0.48, P < .001) and hospital stay (MD = 1.23; 95% CI, 0.60-1.85, P < .001). However, no statistic difference was detected in operative time (MD = 5.40; 95% CI, -1.78 to 12.58, P = .140) between the paired groups. Although DJS showed a higher rate of postoperative complications (25.19% vs 17.61%), there was no significant difference in the incidence of complications following DJS and PCN (RR = 0.92; 95% CI, 0.60-1.43; P = .720). Based on the EuroQol analysis, the 2 main treatment options had different impacts on quality of life. The pooled results showed that PCN patients reported more difficulties in self-care compared to DJS patients (RR = 3.07; 95% CI, 1.32-7.14; P = .009). CONCLUSIONS DJS is a safe and better method of temporary urinary diversion than PCN for management of ureteral obstruction with shorter fluoroscopy time and hospital stay. As for quality of life, patients receiving PCN had a distinct difficulty in self-care compared to those receiving DJS. However, these 2 treatment options often depends on the individual situation.
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Affiliation(s)
- Kai-Ping Zhang
- Department of Urology, Anhui Provincial Children’s Hospital/Children’s Hospital of Fudan University (Affiliated Anhui Branch), Hefei, China
| | - Yin Zhang
- Department of Urology, Anhui Provincial Children’s Hospital/Children’s Hospital of Fudan University (Affiliated Anhui Branch), Hefei, China
| | - Min Chao
- Department of Urology, Anhui Provincial Children’s Hospital/Children’s Hospital of Fudan University (Affiliated Anhui Branch), Hefei, China
- * Correspondence: Min Chao, Department of Urology, Anhui Provincial Children’s Hospital/Children’s Hospital of Fudan University (Affiliated Anhui Branch), No. 39 Wangjiang East Road, Hefei 230051, Anhui Province, P. R. China (e-mail: )
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8
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Gould Rothberg BE, Quest TE, Yeung SCJ, Pelosof LC, Gerber DE, Seltzer JA, Bischof JJ, Thomas CR, Akhter N, Mamtani M, Stutman RE, Baugh CW, Anantharaman V, Pettit NR, Klotz AD, Gibbs MA, Kyriacou DN. Oncologic emergencies and urgencies: A comprehensive review. CA Cancer J Clin 2022; 72:570-593. [PMID: 35653456 DOI: 10.3322/caac.21727] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 12/12/2022] Open
Abstract
Patients with advanced cancer generate 4 million visits annually to emergency departments (EDs) and other dedicated, high-acuity oncology urgent care centers. Because of both the increasing complexity of systemic treatments overall and the higher rates of active therapy in the geriatric population, many patients experiencing acute decompensations are frail and acutely ill. This article comprehensively reviews the spectrum of oncologic emergencies and urgencies typically encountered in acute care settings. Presentation, underlying etiology, and up-to-date clinical pathways are discussed. Criteria for either a safe discharge to home or a transition of care to the inpatient oncology hospitalist team are emphasized. This review extends beyond familiar conditions such as febrile neutropenia, hypercalcemia, tumor lysis syndrome, malignant spinal cord compression, mechanical bowel obstruction, and breakthrough pain crises to include a broader spectrum of topics encompassing the syndrome of inappropriate antidiuretic hormone secretion, venous thromboembolism and malignant effusions, as well as chemotherapy-induced mucositis, cardiomyopathy, nausea, vomiting, and diarrhea. Emergent and urgent complications associated with targeted therapeutics, including small molecules, naked and drug-conjugated monoclonal antibodies, as well as immune checkpoint inhibitors and chimeric antigen receptor T-cells, are summarized. Finally, strategies for facilitating same-day direct admission to hospice from the ED are discussed. This article not only can serve as a point-of-care reference for the ED physician but also can assist outpatient oncologists as well as inpatient hospitalists in coordinating care around the ED visit.
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Affiliation(s)
- Bonnie E Gould Rothberg
- Yale Cancer Center Innovations Laboratory, Yale Comprehensive Cancer Center, New Haven, Connecticut
| | - Tammie E Quest
- Department of Emergency Medicine, Emory University, Atlanta, Georgia
| | - Sai-Ching J Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lorraine C Pelosof
- Office of Oncologic Diseases, US Food and Drug Administration, Silver Spring, Maryland
| | - David E Gerber
- Division of Hematology-Oncology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical School, Dallas, Texas
| | - Justin A Seltzer
- Department of Emergency Medicine, University of California San Diego, San Diego, California
| | - Jason J Bischof
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Charles R Thomas
- Department of Radiation Oncology, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Nausheen Akhter
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mira Mamtani
- Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Robin E Stutman
- Department of Medicine, Division of Urgent Care Services, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher W Baugh
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Venkataraman Anantharaman
- Department of Emergency Medicine, Singapore General Hospital, SingHealth Duke-National University of Singapore Academic Medical Center, Singapore, Singapore
| | - Nicholas R Pettit
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Adam D Klotz
- Department of Medicine, Division of Urgent Care Services, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael A Gibbs
- Department of Emergency Medicine, Atrium Health-Carolinas Medical Center, Charlotte, North Carolina
| | - Demetrios N Kyriacou
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Nóbrega L, Zanon JR, Andrade CEEMDC, Schmidt RL, Dos Santos MH, Dos Reis R. Prognostic role of hydronephrosis in the treatment of patients with locally advanced cervical cancer: a retrospective cohort. Int J Gynecol Cancer 2022; 32:ijgc-2022-003679. [PMID: 35973739 PMCID: PMC9484387 DOI: 10.1136/ijgc-2022-003679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/25/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Obstructive uropathy is present in almost 50% of patients with advanced cervical cancer and is associated with worse outcomes. OBJECTIVE To estimate the prognostic role of hydronephrosis and the impact of ureteral obstruction resolution in patients with locally advanced cervical cancer undergoing treatment. METHODS A retrospective cohort study was conducted of patients with International Federation of Gynecology and Obstetrics 2018 stage IIIB to IVA treated in a tertiary oncologic referral center in Brazil between January 2009 and June 2018. Three different groups were evaluated: (I) without hydronephrosis, (II) with hydronephrosis and urinary diversion, and (III) with hydronephrosis but no urinary diversion. Kaplan-Meier curves and log-rank tests estimated overall survival and progression-free survival based on the presence of hydronephrosis and urinary diversion. Clinicopathological variables were evaluated using univariate and multivariate Cox proportional hazard regression model for overall survival and progression-free survival. RESULTS A total of 151 patients were evaluated: group I - 62 (41.1%); II - 44 (29.1%), and III - 45 (29.8%). Stage, histological type or grade, tumor size, parametrial or lymph node involvement were not statistically different between groups. Group I had more favorable overall survival than groups II (p<0.003) and III (p<0.02); however, no difference was noted between groups II and III. Progression-free survival was similar between groups (log-rank test p=0.95). Univariate analysis revealed hydronephrosis (p=0.002) and concurrent chemoradiotherapy (p<0.001) as a prognostic factor for worse overall survival; while tumor size (p=0.023), pelvic lymphadenopathy (p=0.015), and histological type (p=0.03) were associated with worse progression-free survival. On multivariate analysis, hydronephrosis remained as an independently associated factor with worse overall survival (HR=2.06; 95% CI 1.12 to 3.79, p=0.02). CONCLUSION Patients with locally advanced cervical cancer with hydronephrosis had lower overall survival even after controlling for potential confounding factors, but no difference in progression-free survival. Urinary diversion showed no impact on overall survival or progression-free survival.
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Affiliation(s)
- Leandro Nóbrega
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | - Jeferson Rodrigo Zanon
- Department of Palliative Care and Nephrology, Cancer Hospital of Jales - Barretos Cancer Hospital, Barretos, Brazil
| | | | | | | | - Ricardo Dos Reis
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, Brazil
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10
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Botkin HE, Faidley KN, Loeffler BT, Mott SL, Hill EK, Erickson BA. Longitudinal Outcomes from Conservative Management of Cervical Cancer Associated Ureteral Obstruction. Urology 2021; 158:208-214. [PMID: 34582886 DOI: 10.1016/j.urology.2021.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify predictors of hydronephrosis (HN) resolution and HN treatment failure. HN is a common comorbid condition with cervical cancer (CCa). Treatments for CCa continue to improve and long-term management strategies of HN are becoming increasingly necessary. METHODS A query of a single hospital (2004 - 2019) ICD-9 and CPT codes was made to develop a cohort of CCa patients with HN. A retrospective review was performed. The effects of patient, renal/HN, and cancer covariates on time to HN treatment failure, treatment complications and time to HN resolution were evaluated using logistic regression and competing risk Cox regression models. RESULTS Of the 1670 women treated for CCa during the study period, 179 (10.7%) developed HN (n = 72 (40%) bilateral), 78 (44%) at time of CCa diagnosis and 101 (56%) as a result of treatment, of which 145 (81%) underwent initial treatment with a PCN (n = 77, 53%) or US (n = 68, 47%). Complication rates were similar between PCN (56%) and US (61%) when adjusting for treatment time. Initial treatment failure was more likely with US vs PCN (HR 3.2, P <0.01). HN resolution (n = 32, 22%) without reconstruction was predicted by HN concurrent with CCa diagnosis (HR 3.1, P <0.01) and bilateral HN (HR 0.2, P <0.01). CONCLUSION CCa associated HN has a resolution rate of only 19% at 12 months. Those presenting with HN after CCa treatment are less likely to resolve without reconstruction. PCN and US have similar complication rates but initial US placement has a nearly three times increased risk of failing than PCN.
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Affiliation(s)
- Hannah E Botkin
- Department of Urology, University of Iowa, Carver College of Medicine, Iowa City, Iowa
| | - Kathryn N Faidley
- Department of Urology, University of Iowa, Carver College of Medicine, Iowa City, Iowa
| | | | - Sarah L Mott
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| | - Emily K Hill
- Department of Obstetrics and Gynecology, University of Iowa, Carver College of Medicine
| | - Bradley A Erickson
- Department of Urology, University of Iowa, Carver College of Medicine, Iowa City, Iowa.
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Zhang CL, Xie DQ, Ao LN, Zhu L. A comparative analysis of high-flux and low-flux dialysis in cervical cancer patients with obstructive renal failure showing no significantly improved renal function after catheterisation. Pak J Med Sci 2021; 37:1014-1019. [PMID: 34290775 PMCID: PMC8281144 DOI: 10.12669/pjms.37.4.3515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/17/2020] [Accepted: 03/05/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: This study aims to compare the clinical application value of high-flux dialysis with low-flux dialysis in patients without significantly improved renal function after cervical cancer and obstructive renal failure catheterisation. Methods: This prospective randomised study was conducted from January 2018 to December 2019. Eighty cervical cancer patients with obstructive renal failure who showed no significant renal function improvement after catheterisation were randomised into two groups (n = 40 in each group) in the Second People’s Hospital of Yibin City. High-flux and low-flux dialysis were employed in the experimental group and the control group, respectively. Treatments in both groups were provided every other day, with the whole course lasting one week. Data were recorded before and after dialysis included inflammatory factors such as IL-6, CRP and TNF-a, large and moderate molecular toxins (e.g., β2 micro-globulin, parathyrin (PTH) and cysteine protease inhibitor). Renal function changes during the dialysis were also recorded. Afterwards, the two groups were compared regarding the overall efficacy. Results: Both the experimental group and the control group experienced a significant decrease in IL-6, CRP, TNF-a, β2 micro-globulin, PTH and cysteine protease inhibitor, with the decrease in the experimental group being more evident (p < 0.05). After dialysis was completed, the experimental group restored renal function indicators such as Cre, CysC and serum K+ levels more quickly than the control group (p < 0.05). The effective rate was 100% for the experimental group and 87.5% for the control group. The intragroup difference in the efficacy.was significant. Conclusions: High-flux dialysis appears to be more beneficial for cervical cancer patients with obstructive renal failure, showing no significant improvement in renal function after catheterisation. It restored renal function more quickly, had more radical draining of inflammatory factors and large and moderate molecular toxins, and had a higher overall effective rate.
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Affiliation(s)
- Chen-Li Zhang
- Chen-li Zhang, Department of Nephrology, The Second People's Hospital of Yibin City, Yibin, Sichuan, 644000, P.R. China
| | - De-Qiong Xie
- De-qiong Xie, Department of Nephrology, The Second People's Hospital of Yibin City, Yibin, Sichuan, 644000, P.R. China
| | - Li-Na Ao
- Li-na Ao, Department of Nephrology, The Second People's Hospital of Yibin City, Yibin, Sichuan, 644000, P.R. China
| | - Lei Zhu
- Lei Zhu, Department of Nephrology, The Second People's Hospital of Yibin City, Yibin, Sichuan, 644000, P.R. China
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