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The impact of urological resection and reconstruction on patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)

OBJECTIVE: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are increasingly being used to treat peritoneal malignancies. Urological resections and reconstruction (URR) are occasionally performed during the surgery. We aim to evaluate the impact of these procedures o...

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Autores principales: Tan, Grace Hwei Ching, Shannon, Nicholas B., Chia, Claramae Shulyn, Lee, Lui Shiong, Soo, Khee Chee, Teo, Melissa Ching Ching
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Second Military Medical University 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033198/
https://www.ncbi.nlm.nih.gov/pubmed/29988907
http://dx.doi.org/10.1016/j.ajur.2017.09.003
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author Tan, Grace Hwei Ching
Shannon, Nicholas B.
Chia, Claramae Shulyn
Lee, Lui Shiong
Soo, Khee Chee
Teo, Melissa Ching Ching
author_facet Tan, Grace Hwei Ching
Shannon, Nicholas B.
Chia, Claramae Shulyn
Lee, Lui Shiong
Soo, Khee Chee
Teo, Melissa Ching Ching
author_sort Tan, Grace Hwei Ching
collection PubMed
description OBJECTIVE: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are increasingly being used to treat peritoneal malignancies. Urological resections and reconstruction (URR) are occasionally performed during the surgery. We aim to evaluate the impact of these procedures on peri-operative outcomes of CRS and HIPEC patients. METHODS: A retrospective review of a prospectively maintained database of all patients who underwent CRS-HIPEC from April 2001 to February 2016 was performed. Outcomes between patients who had surgery involving, and not involving URR were compared. Primary outcomes were the rate of major complications and the duration of stay in the intensive care unit (ICU) and hospital. Secondary outcomes were that of overall survival (OS) and prognostic factors that would indicate a need for URR. RESULTS: A total of 214 CRS-HIPEC were performed, 21 of which involved a URR. Baseline clinical characteristics did not vary between the groups (URR vs. No URR). Urological resections comprised of 52% bladder resections, 24% ureteric resections, and 24% involving both bladder and ureteric resections. All bladder defects were closed primarily while ureteric reconstructions consisted of two end-to-end anastomoses, one ureto-uretostomy, five direct implantations into the bladder and three boari flaps. URR were more frequently required in patients with colorectal peritoneal disease (p = 0.029), but was not associated with previous pelvic surgery (76% vs. 54%, p = 0.065). Patients with URR did not suffer more serious complications (14% vs. 24%, p = 0.42). ICU (2.2 days vs. 1.4 days, p = 0.51) and hospital stays (18 days vs. 25 days, p = 0.094) were not significantly affected. Undergoing a URR did not affect OS (p = 0.99), but was associated with increased operation time (570 min vs. 490 min, p = 0.046). CONCLUSION: While concomitant URR were associated with an increase in operation time, there were no significant differences in postoperative complications or OS. Patients with colorectal peritoneal metastases are more likely to require a URR compared to other primary tumours, and needs to be considered during pre-operative planning.
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spelling pubmed-60331982018-07-09 The impact of urological resection and reconstruction on patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) Tan, Grace Hwei Ching Shannon, Nicholas B. Chia, Claramae Shulyn Lee, Lui Shiong Soo, Khee Chee Teo, Melissa Ching Ching Asian J Urol Original Article OBJECTIVE: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are increasingly being used to treat peritoneal malignancies. Urological resections and reconstruction (URR) are occasionally performed during the surgery. We aim to evaluate the impact of these procedures on peri-operative outcomes of CRS and HIPEC patients. METHODS: A retrospective review of a prospectively maintained database of all patients who underwent CRS-HIPEC from April 2001 to February 2016 was performed. Outcomes between patients who had surgery involving, and not involving URR were compared. Primary outcomes were the rate of major complications and the duration of stay in the intensive care unit (ICU) and hospital. Secondary outcomes were that of overall survival (OS) and prognostic factors that would indicate a need for URR. RESULTS: A total of 214 CRS-HIPEC were performed, 21 of which involved a URR. Baseline clinical characteristics did not vary between the groups (URR vs. No URR). Urological resections comprised of 52% bladder resections, 24% ureteric resections, and 24% involving both bladder and ureteric resections. All bladder defects were closed primarily while ureteric reconstructions consisted of two end-to-end anastomoses, one ureto-uretostomy, five direct implantations into the bladder and three boari flaps. URR were more frequently required in patients with colorectal peritoneal disease (p = 0.029), but was not associated with previous pelvic surgery (76% vs. 54%, p = 0.065). Patients with URR did not suffer more serious complications (14% vs. 24%, p = 0.42). ICU (2.2 days vs. 1.4 days, p = 0.51) and hospital stays (18 days vs. 25 days, p = 0.094) were not significantly affected. Undergoing a URR did not affect OS (p = 0.99), but was associated with increased operation time (570 min vs. 490 min, p = 0.046). CONCLUSION: While concomitant URR were associated with an increase in operation time, there were no significant differences in postoperative complications or OS. Patients with colorectal peritoneal metastases are more likely to require a URR compared to other primary tumours, and needs to be considered during pre-operative planning. Second Military Medical University 2018-07 2017-10-04 /pmc/articles/PMC6033198/ /pubmed/29988907 http://dx.doi.org/10.1016/j.ajur.2017.09.003 Text en © 2018 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Tan, Grace Hwei Ching
Shannon, Nicholas B.
Chia, Claramae Shulyn
Lee, Lui Shiong
Soo, Khee Chee
Teo, Melissa Ching Ching
The impact of urological resection and reconstruction on patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)
title The impact of urological resection and reconstruction on patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)
title_full The impact of urological resection and reconstruction on patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)
title_fullStr The impact of urological resection and reconstruction on patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)
title_full_unstemmed The impact of urological resection and reconstruction on patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)
title_short The impact of urological resection and reconstruction on patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)
title_sort impact of urological resection and reconstruction on patients undergoing cytoreductive surgery (crs) and hyperthermic intraperitoneal chemotherapy (hipec)
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033198/
https://www.ncbi.nlm.nih.gov/pubmed/29988907
http://dx.doi.org/10.1016/j.ajur.2017.09.003
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