Risk factors and clinical outcomes in patients undergoing cytoreductive surgery with concomitant ureteric reimplantation

Anais Alonso; Shoma Barat; Helen Kennedy; Meredith Potter; Nayef Alzahrani; David Morris

doi:10.1515/pp-2021-0130

Risk factors and clinical outcomes in patients undergoing cytoreductive surgery with concomitant ureteric reimplantation

Pleura Peritoneum. 2021 Nov 15;6(4):155-160. doi: 10.1515/pp-2021-0130. eCollection 2021 Dec.

Authors

Anais Alonso^{1

2}, Shoma Barat^{1

2}, Helen Kennedy¹, Meredith Potter¹, Nayef Alzahrani^{1

3}, David Morris^{1

2}

Affiliations

¹ Liver and Peritonectomy Unit, St George Hospital, Kogarah, Australia.
² St George and Sutherland Clinical School, University of New South Wales, Kogarah, Australia.
³ College of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia.

Abstract

Objectives: There are currently scarce data exploring ureteric reimplantation (UR) during cytoreductive surgery (CRS).

Methods: We identified patients undergoing CRS for peritoneal surface malignancies (PSM) of any origin at a single high-volume unit. UR was defined as ureteroureterostomy, transureterouretostomy, ureteroneocystostomy, ureterosigmoidostomy or ileal conduit performed during CRS. Peri-operative outcomes, long-term survival and risk factors for requiring UR were analysed.

Results: Seven hundred and sixty-seven CRSs were identified. Twenty-three (3.0%) procedures involved UR. Bladder resection and colorectal cancer (CRC) were associated with increased risk of UR (bladder resection: OR 12.90, 95% CI 4.91-33.90, p<0.001; CRC: OR 2.51, 95% CI 1.05-6.01, p=0.038). UR did not increase the risk of Grade III-IV morbidity or mortality. The rate of ureteric leak was 3/23 (13.0%) in the UR group. Mean survival was equivocal in patients with CRC (58.14 vs. 34.25 months, p=0.441) but significantly lower in those with high-grade appendiceal mucinous neoplasm (HAMN) undergoing UR (73.98 vs. 30.90 months, p=0.029).

Conclusions: UR during CRS does not increase major morbidity or mortality for carefully selected patients, and is associated with low rates of urologic complications. Whilst decreased survival was apparent in patients with HAMN undergoing UR, it is unclear whether this relationship is causal.

Keywords: cytoreductive surgery; peritoneal carcinomatosis; peritoneal surface malignancy; peritonectomy; ureteric reimplantation.