Annals of Surgical Oncology

, Volume 21, Issue 3, pp 868–874

Significance of Urinary Tract Involvement in Patients Treated with Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Authors

    • Surgical Oncology Service, Department of General SurgeryWake Forest University
  • Reese W. Randle
    • Surgical Oncology Service, Department of General SurgeryWake Forest University
  • Brandon Craven
    • Department of UrologyWake Forest University
  • Katrina R. Swett
    • Department of BiostatisticsWake Forest University
  • Edward A. Levine
    • Surgical Oncology Service, Department of General SurgeryWake Forest University
  • Perry Shen
    • Surgical Oncology Service, Department of General SurgeryWake Forest University
  • John H. Stewart
    • Surgical Oncology Service, Department of General SurgeryWake Forest University
  • Majid Mirzazadeh
    • Department of UrologyWake Forest University
Gastrointestinal Oncology

DOI: 10.1245/s10434-013-3354-2

Cite this article as:
Votanopoulos, K.I., Randle, R.W., Craven, B. et al. Ann Surg Oncol (2014) 21: 868. doi:10.1245/s10434-013-3354-2

Abstract

Background

Urinary tract involvement in patients with peritoneal surface disease treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) often requires complex urologic resections and reconstruction to achieve optimal cytoreduction. The impact of these combined procedures on surgical outcomes is not well defined.

Methods

A prospective database of CRS/HIPEC procedures was analyzed retrospectively. Type of malignancy, performance status, resection status, hospital and intensive care unit stay, morbidity, mortality, and overall survival were reviewed.

Results

A total of 864 patients underwent 933 CRS/HIPEC procedures, while 64 % (550) had preoperative ureteral stent placement. A total of 7.3 % had an additional urologic procedure without an increase in 30-day (p = 0.4) or 90-day (p = 1.0) mortality. Urologic procedures correlated with increased length of operating time (p < 0.001), blood loss (p < 0.001), and length of hospitalization (p = 0.003), yet were not associated with increased overall 30-day major morbidity (grade III/IV, p = 0.14). In multivariate analysis, independent predictors of additional urologic procedures were prior surgical score (p < 0.001), number of resected organs (p = 0.001), and low anterior resection (p = 0.03). Long-term survival was not statistically different between patients with and without urologic resection for low-grade appendiceal primary lesions (p = 0.23), high-grade appendiceal primary lesions (p = 0.40), or colorectal primary lesions (p = 0.14).

Conclusions

Urinary tract involvement in patients with peritoneal surface disease does not increase overall surgical morbidity. Patients with urologic procedures demonstrate survival patterns with meaningful prolongation of life. Urologic involvement should not be considered a contraindication for CRS/HIPEC in patients with resectable peritoneal surface disease.

Copyright information

© Society of Surgical Oncology 2013