Clinical features and surgical outcomes of major urological interventions during cytoreductive surgery and hyperthermic intraperitoneal chemotheraphy

Our plain-English summary of Clinical features and surgical outcomes of major urological interventions during cytoreductive surgery and hyperthermic intraperitoneal chemotheraphy, by Ö. Düzgün, M. Kalın, R. Sobay, et al (Therapeutic Advances in Urology, 2020).

The study

• Authors: Ö. Düzgün, M. Kalın, R. Sobay, Ö.F. Özkan
• Journal: Therapeutic Advances in Urology
• Published: 2020;12:1756287220975923
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Urinary system resections and reconstructions are needed in peritoneal carcinomatosis due to abdominal malignancies. The effect of hyperthermic intraperitoneal chemotherapy on these urological procedures after reconstruction remains uncertain. The aim of the study is to evaluate major urological interventions during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in complex abdominal malignancies with peritoneal carcinomatosis.

Methods: Forty-four cases underwent surgical intervention related to the urinary system among 208 cases who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy because of peritoneal carcinomatosis. Urinary system procedures performed in these patients (radical-partial cystectomy, partial ureter resection ureteroneocystostomy, ureteroureterostomy, nephrectomy) were evaluated in terms of postoperative morbidity-mortality and survival.

Results: Urinary system resections were performed during cytoreductive surgery in a total of 44 cases. The mean age was 54 years (20-73). Patients were diagnosed with peritoneal carcinomatosis due to colorectal cancer in 21 (47.8%), ovarian cancer in nine (20.4%), sarcomatosis in five (11.4%), cervical cancer in four (9%) and other cancers (mesothelioma, uterus, breast, gastric) in five (11.4%) cases. Total nephrectomy was performed in three cases and partial nephrectomy in one case. Cystectomy was performed in 21 cases; 16 of these were partial and five were total cystectomies. Ureteroureterocystostomy with double J was performed in four cases and ureteroneocystostomy in 12 cases. While Clavian-Dindo grade 3-4 complications were seen in nine cases (20.4%), three cases (6.8%) became exitus during the first 30-day follow-up.

Conclusions: Although urinary system involvements have been regarded as inoperable in the past, we think that with adequate experience radical urinary interventions performed in suitable patients can be carried out with acceptable morbidity and mortality as seen in our series.

© The Author(s), 2020.

In plain English

This study did not examine asbestos exposure. It was a retrospective case series from a hospital in Istanbul, Turkey. Of 208 patients treated there from May 2016 to May 2020 with cytoreductive surgery and heated abdominal chemotherapy (HIPEC) for cancer spread across the abdominal lining, 44 also had major urinary surgery. These included partial or total removal of the bladder or a kidney, and ureter repairs. Twenty-one of the 44 had colorectal cancer. Five had other cancers, including an unstated number with mesothelioma. Among the 44, nine (20.4%) had serious complications (Clavien-Dindo grade 3 to 4) and three had urine leakage. Three deaths were reported within 30 days, but a later account describes deaths from the same causes in months two and three, leaving the timing unclear. Median overall survival was 30 months (95% confidence interval 24 to 36). Survival at 1, 2 and 3 years was 71%, 65% and 60%. The authors concluded that, with adequate experience, such urinary surgery in suitable patients can be done with acceptable complications and deaths. They noted that the series was small and mixed, with no control group.

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 case series from a single hospital, using prospectively recorded data
• Who was studied: 44 patients who had major urinary system surgery, out of 208 patients who had cytoreductive surgery plus HIPEC for peritoneal carcinomatosis at Health Sciences University Umraniye Teaching and Research Hospital, Istanbul, Turkey, May 2016 to May 2020. There were 30 women and 14 men, with a mean age of 54 years (range 20 to 73).
• Exposure: No asbestos or fiber exposure was studied or mentioned. The treatment examined was urinary system surgery during cytoreductive surgery plus HIPEC: partial or total cystectomy, partial ureter resection with ureteroureterostomy, ureteroneocystostomy, total or partial nephrectomy, and repair of bladder injury.
• Main results:
  • Diagnoses among the 44 patients were colorectal tumors in 21 (47.8%), ovarian cancer in nine (20.4%), sarcomatosis in five (11.4%) and cervical cancer in four (9%). Other cancers (uterus, gastric, breast, mesothelioma) made up five (11.4%). The number with mesothelioma is not given separately.
  • Procedures were: total nephrectomy in three and partial nephrectomy in one; cystectomy in 21 (16 partial, 5 total); ureteroureterostomy in four; ureteroneocystostomy in 12; ureter ligation with nephrostomy in seven; and repair of bladder injury in eight.
  • Among the 44 patients, Clavien-Dindo grade 3A, 3B or 4 complications occurred in nine (20.4%).
  • The article reports three deaths (6.8%) among the 44 in the first 30-day follow-up (pulmonary embolism, myocardial infarction, pneumonia). Its follow-up account describes deaths from pulmonary embolism and myocardial infarction in the second month and from pneumonia in the third month. The article does not say whether these are the same deaths, so their timing is unclear.
  • Urinary leakage was found in three of the 44 patients.
  • For the 44 patients, median overall survival was 30 months, with a 95% confidence interval of 24 to 36 months (Table 4).
  • For the 44 patients, survival at 1, 2 and 3 years was 71%, 65% and 60%.
• The authors' conclusion: The authors concluded that, with adequate experience, radical urinary surgery in suitable patients can be carried out with acceptable complications and deaths, as seen in their series.
• Limitations the authors state:
  • The study was a retrospective case series of a mixed (heterogeneous) group of patients.
  • The number of cases was small, and there was no randomized control group.

Topics

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Colorectal Cancer, Ovarian Cancer, Mesothelioma.

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• Urological approach for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a clinical care center — C.G. Trujillo, C. Domínguez, et al. (2018)
• 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)
• A Novel Tool for Predicting Major Complications After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy — J.M. Baumgartner, T.G. Kwong, et al. (2016)
• Malignant peritoneal mesothelioma treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is GLUT1 expression a major prognostic factor? A preliminary study — J. Hommell-Fontaine, S. Isaac, et al. (2013)
• Impact of Major Complications on Patients' Quality of Life After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy — T.D. Hamilton, E.L. Taylor, et al. (2016)
• Influence of the effectiveness of sarcopenia on postoperative major complications after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal surface malignancy: a retrospective cohort study — N. Havan, S. Gülmez, et al. (2025)

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