1
|
Yang H, Jiang P, Zhang Z, Zhou Y, Li P, Zeng Q, Zhang X, Sun Y. Laparoscopic Ureteric Reconstruction After Partial Ureterectomy for Locally Advanced and Recurrent Pelvic Malignancies (with Video). Ann Surg Oncol 2024:10.1245/s10434-024-15947-w. [PMID: 39078599 DOI: 10.1245/s10434-024-15947-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/17/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND The urinary tract is one of the most frequently involved organs in advanced non-urologic pelvic malignances. Extensive resection of ureteric organs is mandatory during a curative surgery. Urinary reconstruction after partial ureterectomy, the most challenging situation, is associated with a higher incidence of complication than cystectomy, especially when performed with laparoscopy. Furthermore, to date, no generally accepted strategy for urinary reconstruction after extensive tumor resection with partial ureterectomy has been established. METHODS The study identified and scrutinized intraoperative videos and clinical records of patients with locally advanced or recurrent pelvic malignancies who underwent segmental ureterectomy during en bloc resection of advanced tumors between February 2020 and February 2024. RESULTS The study enrolled nine patients, including four cases managed by ureteroureteral anastomosis, two cases managed by ureteroneocystomy, two cases managed by Boari flap reconstruction, and one case managed by ileal interposition. In all nine cases, R0 margins were obtained, and no case needed conversion to laparotomy. No clinical evidence of postoperative urinary leakage was identified. The median follow-up period was 14 months (range, 5-19 months). In three of the nine cases, recurrence was identified, at the 3rd, 18th, and 19th month follow-up evaluations, respectively. One patient died of systemic metastasis. CONCLUSIONS Laparoscopic ureteric reconstruction is feasible for patients who undergo segmental ureterectomy during extensive surgery for locally advanced or recurrent pelvic malignancies. A low anastomotic leakage rate and favorable postoperative renal function could be achieved in this study when anastomosis was performed laparoscopically.
Collapse
Affiliation(s)
- Hongjie Yang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, People's Republic of China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, People's Republic of China
- Nankai University, Tianjin, People's Republic of China
- Tianjin Institute of Coloproctology, Tianjin, People's Republic of China
| | - Peishi Jiang
- Nankai University, Tianjin, People's Republic of China
| | - Zhichun Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, People's Republic of China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, People's Republic of China
- Nankai University, Tianjin, People's Republic of China
- Tianjin Institute of Coloproctology, Tianjin, People's Republic of China
| | - Yuanda Zhou
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, People's Republic of China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, People's Republic of China
- Nankai University, Tianjin, People's Republic of China
- Tianjin Institute of Coloproctology, Tianjin, People's Republic of China
| | - Peng Li
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, People's Republic of China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, People's Republic of China
- Nankai University, Tianjin, People's Republic of China
- Tianjin Institute of Coloproctology, Tianjin, People's Republic of China
| | - Qingsheng Zeng
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, People's Republic of China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, People's Republic of China
- Nankai University, Tianjin, People's Republic of China
- Tianjin Institute of Coloproctology, Tianjin, People's Republic of China
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, People's Republic of China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, People's Republic of China
- Nankai University, Tianjin, People's Republic of China
- Tianjin Institute of Coloproctology, Tianjin, People's Republic of China
| | - Yi Sun
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, People's Republic of China.
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, People's Republic of China.
- Nankai University, Tianjin, People's Republic of China.
- Tianjin Institute of Coloproctology, Tianjin, People's Republic of China.
| |
Collapse
|
2
|
Palma CA, van Kessel CS, Solomon MJ, Leslie S, Jeffery N, Lee PJ, Austin KKS. Bladder preservation or complete cystectomy during pelvic exenteration of patients with locally advanced or recurrent rectal cancer, what should we do? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1250-1257. [PMID: 36658054 DOI: 10.1016/j.ejso.2023.01.002] [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: 10/10/2022] [Revised: 12/15/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Abstract
INTRODUCTION In patients with locally advanced (LARC) or locally recurrent (LRRC) rectal cancer and bladder involvement, pelvic exenteration (PE) with partial (PC) or radical (RC) cystectomy can potentially offer a cure. The study aim was to compare PC and RC in PE patients in terms of oncological outcome, post-operative complications and quality-of-life (QoL). MATERIALS & METHODS This was a retrospective cohort analysis of a prospectively maintained surgical database. Patients who underwent PE for LARC or LRRC cancer with bladder involvement between 1998 and 2021 were included. Post-operative complications and overall survival were compared between patients with PC and RC. RESULTS 60 PC patients and 269 RC patients were included. Overall R0 resection was 84.3%. Patients with LRRC and PC had poorest oncological outcome with 69% R0 resection; patients with LARC and PC demonstrated highest R0 rate of 96.3% (P = 0.008). Overall, 1-, 3- and 5-year OS was 90.8%, 68.1% and 58.6% after PC, and 88.7%, 62.2% and 49.5% after RC. Rates of urinary sepsis or urological leaks did not differ between groups, however, RC patients experienced significantly higher rates of perineal wound- and flap-related complications (39.8% vs 25.0%, P = 0.032). CONCLUSION PC as part of PE can be performed safely with good oncological outcome in patients with LARC. In patients with LRRC, PC results in poor oncological outcome and a more aggressive surgical approach with RC seems justified. The main benefit of PC is a reduction in wound related complications compared to RC, although more urological re-interventions are observed in this group.
Collapse
Affiliation(s)
- Catalina A Palma
- Department of Urology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Charlotte S van Kessel
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia; Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia; Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Institute of Academic Surgery at RPA, Sydney, Australia; University of Sydney, New South Wales, Australia.
| | - Scott Leslie
- Institute of Academic Surgery at RPA, Sydney, Australia; University of Sydney, New South Wales, Australia; Department of Urology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Nicola Jeffery
- Department of Urology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Peter J Lee
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia; Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia; University of Sydney, New South Wales, Australia
| | - Kirk K S Austin
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia; Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| |
Collapse
|
3
|
Kim JH, Lee DE, Ha HI, Jung JY, Kim SH, Lee HH, Seo HK, Seo SS, Kang S, Park SY, Lim MC. Surgical outcomes of ureteral reconstruction during cytoreductive surgery for ovarian cancer: a retrospective cohort study. BMC Cancer 2022; 22:1163. [PMID: 36357914 PMCID: PMC9650832 DOI: 10.1186/s12885-022-10288-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/20/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Ureteral reconstruction is required after surgical resection of the tumor invading the urinary tract in ovarian cancer with low incidence. There are no currently reported surgical outcomes of ureteral reconstruction during cytoreductive surgery. The aim of the study is to investigate the clinical features and surgical outcomes of ureteral reconstruction during primary, interval and secondary cytoreductive surgery for ovarian cancer. METHODS: A total of 3226 patients who underwent primary, interval or secondary cytoreductive surgery for ovarian cancer between January 2000 and May 2021 were reviewed. Fifty-six patients who underwent ureteral reconstruction during cytoreductive surgery were included in the analysis. RESULTS: Ureteral reconstruction was required in 1.7% (56/3226) of ovarian cancer patients. Of the 56 patients who underwent ureteral reconstruction during cytoreductive surgery, 35 (62.5%) had primary ovarian cancer, and 21 (37.5%) had recurrent ovarian cancer. The median tumor size invading the lower urinary tract was 2.0 cm (range, 0.4-9.5 cm). Ureteroneocystostomy with direct implantation (51.8%) and psoas hitch (8.9%), transureteroureterostomy (7.1%), and ureteroureterostomy (32.1%) were required as part of cytoreductive surgery. Complete cytoreduction with ureteral reconstruction was achieved in 83.9% (47/56) and the rest of the patient population (16.1%) achieved a gross residual tumor size of less than 1 cm. All complications, including hydronephrosis (33.9%), were managed, none resulting in long-term sequelae. In primary ovarian cancer, the 5-year disease-free survival and overall survival were 50.0% and 89.5%, respectively. In patients with recurrent ovarian cancer, the 5-year disease-free survival and overall survival were 23.6% and 64.0%, respectively. CONCLUSIONS Ureteral reconstruction as a part of cytoreductive surgery for ovarian cancer could be performed with acceptable morbidities. Complete cytoreduction by a multidisciplinary surgical team, including urologic oncologists, should be pursued for the surgical management of ovarian cancer. TRIAL REGISTRATION Retrospectively registered.
Collapse
Affiliation(s)
- Ji Hyun Kim
- Center for Gynecologic Cancer, National Cancer Center, 323, Ilsan-Ro, Ilsandong-Gu, Gyeonggi-Do, Goyang-Si, 10408, Republic of Korea
| | - Dong-Eun Lee
- Biostatistics Collaboration Team, National Cancer Center, Goyang, Republic of Korea
| | - Hyeong In Ha
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Jae Young Jung
- Department of Urology, National Cancer Center, Goyang, Republic of Korea
- Center for Clinical Trials, National Cancer Center, Goyang, Republic of Korea
| | - Sung Han Kim
- Department of Urology, National Cancer Center, Goyang, Republic of Korea
| | - Hyung Ho Lee
- Department of Urology, National Cancer Center, Goyang, Republic of Korea
| | - Ho Kyung Seo
- Department of Urology, National Cancer Center, Goyang, Republic of Korea
- Department of Tumor Immunology, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Sang-Soo Seo
- Center for Gynecologic Cancer, National Cancer Center, 323, Ilsan-Ro, Ilsandong-Gu, Gyeonggi-Do, Goyang-Si, 10408, Republic of Korea
| | - Sokbom Kang
- Center for Gynecologic Cancer, National Cancer Center, 323, Ilsan-Ro, Ilsandong-Gu, Gyeonggi-Do, Goyang-Si, 10408, Republic of Korea
| | - Sang-Yoon Park
- Center for Gynecologic Cancer, National Cancer Center, 323, Ilsan-Ro, Ilsandong-Gu, Gyeonggi-Do, Goyang-Si, 10408, Republic of Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, National Cancer Center, 323, Ilsan-Ro, Ilsandong-Gu, Gyeonggi-Do, Goyang-Si, 10408, Republic of Korea.
- Center for Clinical Trials, National Cancer Center, Goyang, Republic of Korea.
- Department of Tumor Immunology, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
- Rare and Pediatric Cancer Branch and Immuno-Oncology Branch, Division of Rare and Refractory Cancer, Research Institute, National Cancer Center, Goyang, Republic of Korea.
| |
Collapse
|
4
|
Leray H, Angeles MA, Vergriete K, Navarro AS, Martinez A, Ferron G. Psoas hitch ureteral reimplantation in 10 steps in oncologic surgery. Int J Gynecol Cancer 2022; 32:ijgc-2022-003657. [PMID: 35918075 DOI: 10.1136/ijgc-2022-003657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Hélène Leray
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole Departement de chirurgie, Toulouse, France
| | - Martina Aida Angeles
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole Departement de chirurgie, Toulouse, France
| | - Kelig Vergriete
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole Departement de chirurgie, Toulouse, France
| | - Anne-Sophie Navarro
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole Departement de chirurgie, Toulouse, France
| | - Alejandra Martinez
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole Departement de chirurgie, Toulouse, France
| | - Gwenael Ferron
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole Departement de chirurgie, Toulouse, France
| |
Collapse
|
5
|
Kinoshita A, Yamada D, Honda K, Danno T, Tokunaga M, Miyakawa J, Taguchi S, Akiyama Y, Yamada Y, Sato Y, Kume H. [AUTOTRANSPLANTATION FOR IATROGENIC URETERAL INJURY FOLLOWING GYNECOLOGICAL SURGERY]. Nihon Hinyokika Gakkai Zasshi 2022; 113:147-151. [PMID: 37866936 DOI: 10.5980/jpnjurol.113.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
A 48-year-old woman underwent total hysterectomy and oophorectomy for uterine fibroids and bilateral ovarian cysts. Postoperatively, her renal function worsened, and the histological specimen contained ureteral tissue. She was referred to our department for left ureteral injury repair. An anterograde pyelogram revealed a ureteral defect, 9.5 cm in size. We considered ureteral bladder anastomosis to be complicated. She underwent kidney autotransplantation into her right iliac fossa to repair the ureteral injury. Six months after the operation, renal function was preserved, no hydronephrosis was observed by ultrasonography, and renal blood flow was good. Based on the literature on the difficulty of reconstructing ureteral injury, we developed an algorithm based on the length of ureteral injury.
Collapse
Affiliation(s)
- Akane Kinoshita
- Department of Urology, Graduate School of Medicine, The University of Tokyo
| | - Daisuke Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo
| | - Kazuki Honda
- Department of Urology, Graduate School of Medicine, The University of Tokyo
| | - Tetsuya Danno
- Department of Urology, Graduate School of Medicine, The University of Tokyo
| | - Mayuko Tokunaga
- Department of Urology, Graduate School of Medicine, The University of Tokyo
| | - Jimpei Miyakawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo
| | - Satoru Taguchi
- Department of Urology, Graduate School of Medicine, The University of Tokyo
| | - Yoshiyuki Akiyama
- Department of Urology, Graduate School of Medicine, The University of Tokyo
| | - Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo
| | - Yusuke Sato
- Department of Urology, Graduate School of Medicine, The University of Tokyo
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo
| |
Collapse
|
6
|
Meng L, Huang Z, Liu J, Lai H, Zuo H, Liao J, Lin Y, Tang W, Mo X. En bloc resection of a T4B stage cancer of the hepatic flexure of the colon invading the liver, gall bladder, and pancreas/duodenum: A case report. Clin Case Rep 2020; 8:3524-3528. [PMID: 33363965 PMCID: PMC7752350 DOI: 10.1002/ccr3.3455] [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: 05/09/2020] [Revised: 09/22/2020] [Accepted: 10/05/2020] [Indexed: 01/17/2023] Open
Abstract
A T4B hepatic flexure of colon cancer that had invaded the liver, gall bladder, and pancreas/duodenum was removed through a D3 expanded right hemicolectomy + pancreaticoduodenectomy +sectional VI and VII hepatic segmentectomy.
Collapse
Affiliation(s)
- Linghou Meng
- Guangxi Clinical Research Center for Colorectal CancerGuangxi Cancer HospitalNanningChina
| | - Zigao Huang
- Guangxi Clinical Research Center for Colorectal CancerGuangxi Cancer HospitalNanningChina
| | - Jungang Liu
- Guangxi Clinical Research Center for Colorectal CancerGuangxi Cancer HospitalNanningChina
| | - Hao Lai
- Guangxi Clinical Research Center for Colorectal CancerGuangxi Cancer HospitalNanningChina
| | - Hongqun Zuo
- Guangxi Clinical Research Center for Colorectal CancerGuangxi Cancer HospitalNanningChina
| | - Jiankun Liao
- Guangxi Clinical Research Center for Colorectal CancerGuangxi Cancer HospitalNanningChina
| | - Yuan Lin
- Guangxi Clinical Research Center for Colorectal CancerGuangxi Cancer HospitalNanningChina
| | - Weizhong Tang
- Guangxi Clinical Research Center for Colorectal CancerGuangxi Cancer HospitalNanningChina
| | - Xianwei Mo
- Guangxi Clinical Research Center for Colorectal CancerGuangxi Cancer HospitalNanningChina
| |
Collapse
|
7
|
Federico A, Gallotta V, Foschi N, Costantini B, Conte C, Pinto F, Ercoli A, Ferrandina G, Dal Moro F, Bassi P, Zattoni F, Scambia G, Vizzielli G. Surgical outcomes of segmental ureteral resection with ureteroneocystostomy after major gynecologic surgery. Eur J Surg Oncol 2020; 46:1366-1372. [PMID: 32278519 DOI: 10.1016/j.ejso.2020.03.216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/09/2020] [Accepted: 03/21/2020] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Describing the surgical and oncological outcome of bladder-preserving ureter reconstruction (BPUR) with segmental ureteral resection after major gynecologic surgery. MATHERIALS AND METHODS Patients with BPUR admitted at a single institution between March 2012 and July 2018 were retrospectively analyzed. Surgical and oncological data were assessed. RESULTS Forty-six women with gynecologic tumors involving the ureter were treated with BPUR. R0 resection was achieved in 40/46 patients (86.9%), while pathologic margins were microscopically positive in 6 women (13.1%). Overall, 12 women (26.0%) received radiotherapy before surgery: among them, 8 patients received neoadjuvant chemoradiotherapy. Twenty-six women underwent BPUR during primary surgery, whereas 20 (43.4%) required BPUR upon recurrence. Twenty-six patients (56.2%) were found to have hydronephrosis at pre-operative workup. The psoas bladder hitch was the most common procedure performed for urinary reconstruction (63%) with respect to direct reimplantation (37%). Fourteen patients (14/46 = 30.4%) experienced urological complications. Urinary leakage occurred in 9 patients (19.5%), specifically: 5 uretero-vaginal fistula, 3 uroperitoneum, 1 uretero-enteral fistula. There were 3 cases (6.5%) of hydronephrosis at the side of ureteroneocystostomy and 2 cases (4.3%) of unilateral renal impairment requiring nephrectomy. At multivariate analysis only pre-operative radiotherapy (p = 0.047) and a history of pelvic irradiation (p = 0.025) were independently associated with an increased risk of developing severe urinary complications. CONCLUSIONS BPUR is feasible in gynecologic cancer with invasion of the urinary tract. However, since a slight increase of post-operative urological complications was observed in the previously irradiated fields, a personalized surgical planning is recommended for these women in the next future.
Collapse
Affiliation(s)
- Alex Federico
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Valerio Gallotta
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Nazario Foschi
- Division of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Barbara Costantini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Carmine Conte
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Francesco Pinto
- Division of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Alfredo Ercoli
- Department of Obstetrics and Gynecology, University of Messina, Messina, Italy
| | - Gabriella Ferrandina
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabrizio Dal Moro
- Department of Surgery, Oncology and Gastroenterology-Urology, University of Padua, Padua, Italy
| | - Pierfrancesco Bassi
- Division of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Filiberto Zattoni
- Department of Surgery, Oncology and Gastroenterology-Urology, University of Padua, Padua, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Vizzielli
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Department of Surgery, Oncology and Gastroenterology-Urology, University of Padua, Padua, Italy.
| |
Collapse
|
8
|
Complications and 5-year survival after radical resections which include urological organs for locally advanced and recurrent pelvic malignancies: analysis of 646 consecutive cases. Tech Coloproctol 2020; 24:181-190. [DOI: 10.1007/s10151-019-02141-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
|
9
|
Bolmstrand B, Nilsson PJ, Holm T, Buchli C, Palmer G. Patterns of complications following urinary tract reconstruction after multivisceral surgery in colorectal and anal cancer. Eur J Surg Oncol 2018; 44:1513-1517. [PMID: 30017328 DOI: 10.1016/j.ejso.2018.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 06/14/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Multi-visceral resection, including parts of the urinary tract, is sometimes warranted to achieve cancer clear resection margins and optimize survival in patients with locally advanced colorectal and anal cancer. The aim of this study was to assess morbidity after urinary tract reconstruction dictated by colorectal and anal malignancy and to identify potential predictors of urological complications. METHODS All patients undergoing surgery for colorectal or anal malignancy, including urinary tract resection and synchronous reconstruction, performed at the Karolinska University Hospital during 2004-2015 were included in this retrospective cohort study. Data was collected from medical records with follow-up until at least one year after the index surgery. Complications were graded according to the Clavien-Dindo classification system of surgical complications. RESULTS The study included 189 patients; 121 underwent cystectomy and 68 partial ureter resection. The rate of high grade urological complications was 22%. The risk of major urological complications was significantly higher in patients subjected to ureter resection compared to after cystectomy (OR 2.60, 95% CI 1.23-5.49). Also, preoperative radiotherapy and intestinal anastomotic dehiscence significantly increased the risk of high grade urological complications. CONCLUSION To achieve potentially curative resections with uninvolved margins in patients with locally advanced colorectal and anal cancer, multi-visceral resection including urinary tract reconstruction can be performed with reasonable morbidity.
Collapse
Affiliation(s)
- Björn Bolmstrand
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Center of Digestive Diseases, P9:03, Karolinska University Hospital, S-171 76, Stockholm, Sweden.
| | - Per J Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Center of Digestive Diseases, P9:03, Karolinska University Hospital, S-171 76, Stockholm, Sweden
| | - Torbjörn Holm
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Center of Digestive Diseases, P9:03, Karolinska University Hospital, S-171 76, Stockholm, Sweden
| | - Christian Buchli
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Center of Digestive Diseases, P9:03, Karolinska University Hospital, S-171 76, Stockholm, Sweden
| | - Gabriella Palmer
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Center of Digestive Diseases, P9:03, Karolinska University Hospital, S-171 76, Stockholm, Sweden
| |
Collapse
|