Ureteral stenting in cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy as a routine procedure: evidence and necessity

Our plain-English summary of Ureteral stenting in cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy as a routine procedure: evidence and necessity, by F. Coccolini, M. Lotti, R. Manfredi, et al (Urologia Internationalis, 2012).

The study

• Authors: F. Coccolini, M. Lotti, R. Manfredi, F. Catena, C. Vallicelli, P.A. De Iaco, L. Da Pozzo, L. Frigerio, L. Ansaloni
• Journal: Urologia Internationalis
• Published: 2012;89(3):307-10
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: There is a need for more exhaustive data concerning the use of prophylactic ureteral stenting for extended debulking and cytoreductive procedures in the literature.

Material And Methods: A retrospective analysis of the CARPEPACEM study protocol database was performed. The trial protocol schedules the positioning of bilateral ureteral stents before cytoreductive surgery + hyperthermic intraperitoneal chemotherapy (HIPEC).

Results: Fifty-one operated patients: 31 (59.6%) with peritoneal dissemination from ovarian cancer, 8 (15.3%) from colorectal cancer, 4 (7.9%) from pseudomyxoma peritonei, 3 (5.7%) from gastric cancer, 2 (3.8%) from peritoneal mesothelioma, 1 (1.9%) from appendiceal cancer, 1 (1.9%) from endometrial cancer, and 1 (1.9%) from leiomyosarcoma. Mean and median peritoneal cancer index: 11 and 10 (range: 0-28). CC-score: CC-0 in 45 (86.5%) patients, CC-1 in 5 (9.6%) and CC-2 in 1 (1.9%). HIPEC was performed with platinum + taxol in 22 patients (42.3%), platinum + adriablastin in 10 (19.2%), mitomycin in 9 (17.3%), platinum + mitomycin in 7 (13.4%), platinum + doxorubicin in 2 (3.8%), and taxol + adriablastin in 1 (1.9%). Two major ureteral complications were observed (3.9%).

Discussion: Prophylactic ureteral stenting could reduce the risk of postoperative ureteral complications without an increase in stent placement-related complications; however, a randomized clinical trial is needed.

Copyright © 2012 S. Karger AG, Basel.

In plain English

This retrospective study reviewed patients enrolled at two Italian hospitals, in Bologna and Bergamo, in a trial called CARPEPACEM. The trial tested extensive surgery to remove cancer spread through the abdomen, followed by heated chemotherapy circulated inside the abdomen (HIPEC). It required stents (tubes) in both ureters, which drain the kidneys, before surgery. From 2009, 52 patients were enrolled, 45 women and 7 men. Most had ovarian cancer and 2 had peritoneal mesothelioma. Fifty-one went on to surgery and HIPEC. Two patients (3.9%) had a major ureteral complication after surgery. Each had a urinary fistula treated with a percutaneous nephrostomy (a drain into the kidney), and in one of them the stent had been removed during the operation. No patient had a urinary tract infection. The only minor complication, seen in most patients, was self-limiting blood in the urine. The authors concluded that preventive stenting seems to reduce ureteral complications without more stent-related complications, but that a randomized controlled trial is needed. The article does not discuss asbestos.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: retrospective analysis of a two-center trial database (case series of patients who all received preventive ureteral stents)
• Who was studied: 52 patients with cancer spread within the abdomen, enrolled from 2009 at two hospitals in Bologna and Bergamo, Italy: 45 women and 7 men. 31 had ovarian cancer and 2 had peritoneal mesothelioma. 51 of the 52 went on to surgery plus HIPEC.
• Exposure: Not an asbestos exposure. The intervention studied was preventive placement of stents in both ureters (JJ silastic stents) before cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC).
• Main results:
  • Two patients (3.9%) had a major ureteral complication after surgery.
  • In one of these two patients, a bladder resection was done and the ureteral stent was removed during the procedure. This patient later developed a urinary fistula. The other patient also developed a urinary fistula.
  • Both patients with major complications were treated with a percutaneous nephrostomy.
  • No patient had a urinary tract infection.
  • Self-limiting hematuria (blood in the urine), seen in most patients, was the only minor complication.
  • In 4 patients (7.9%), pelvic exenteration with cutaneous ureterostomy was needed because of the condition of the pelvis.
  • In one patient, a ureter injured during pelvic lymph node removal had to be stitched. This patient had no urinary complications.
• The authors' conclusion: The authors concluded that preventive ureteral stenting before cytoreductive surgery plus HIPEC seems to reduce the risk of postoperative ureteral complications, without evidence of more stent-related complications.
• Limitations the authors state:
  • The authors stated that a randomized controlled trial is needed to clarify definitively whether preventive stenting is useful.

Topics

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Bilateral, Ovarian Cancer, Colorectal Cancer, Stomach Cancer, Peritoneal Mesothelioma, Peritoneal Cancer Index (PCI).

Related studies

• A proposal of Brazilian Society of Surgical Oncology (BSSO/SBCO) for standardizing cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) procedures in Brazil: pseudomixoma peritonei, appendiceal tumors and malignant peritoneal mesothelioma — T.P. Batista, B.J.Q. Sarmento, et al. (2017)
• Iterative procedures combining cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for isolated peritoneal recurrence — M. Vaira, M. Robella, et al. (2014)
• Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies — G. Passot, N. Bakrin, et al. (2014)
• Utility of Chemoresponse Assay in Patients Undergoing Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy — S. Bhagwandin, S. Naffouje, et al. (2015)
• Multicystic peritoneal mesothelioma: outcomes and patho-biological features in a multi-institutional series treated by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — D. Baratti, M. Vaira, et al. (2010)
• Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients — G. Passot, N. Bakrin, et al. (2014)

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