Surgical outcomes of segmental ureteral resection with ureteroneocystostomy after major gynecologic surgery.
Adult
Aged
Chemoradiotherapy, Adjuvant
Cystotomy
/ adverse effects
Female
Genital Neoplasms, Female
/ complications
Humans
Hydronephrosis
/ etiology
Intestinal Fistula
/ etiology
Middle Aged
Neoadjuvant Therapy
/ adverse effects
Neoplasm Recurrence, Local
/ surgery
Neoplasm, Residual
Organ Sparing Treatments
Postoperative Complications
/ etiology
Radiotherapy, Adjuvant
/ adverse effects
Plastic Surgery Procedures
/ adverse effects
Risk Factors
Treatment Outcome
Ureter
/ pathology
Urinary Bladder
/ surgery
Urinary Fistula
/ etiology
Vaginal Fistula
/ etiology
Gynecologic malignancies
Personalized surgery
Psoas hitch reconstruction
Surgical complications
Ureteral resection
Journal
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
ISSN: 1532-2157
Titre abrégé: Eur J Surg Oncol
Pays: England
ID NLM: 8504356
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
01
12
2019
revised:
09
03
2020
accepted:
21
03
2020
pubmed:
13
4
2020
medline:
30
12
2020
entrez:
13
4
2020
Statut:
ppublish
Résumé
Describing the surgical and oncological outcome of bladder-preserving ureter reconstruction (BPUR) with segmental ureteral resection after major gynecologic surgery. Patients with BPUR admitted at a single institution between March 2012 and July 2018 were retrospectively analyzed. Surgical and oncological data were assessed. Forty-six women with gynecologic tumors involving the ureter were treated with BPUR. R0 resection was achieved in 40/46 patients (86.9%), while pathologic margins were microscopically positive in 6 women (13.1%). Overall, 12 women (26.0%) received radiotherapy before surgery: among them, 8 patients received neoadjuvant chemoradiotherapy. Twenty-six women underwent BPUR during primary surgery, whereas 20 (43.4%) required BPUR upon recurrence. Twenty-six patients (56.2%) were found to have hydronephrosis at pre-operative workup. The psoas bladder hitch was the most common procedure performed for urinary reconstruction (63%) with respect to direct reimplantation (37%). Fourteen patients (14/46 = 30.4%) experienced urological complications. Urinary leakage occurred in 9 patients (19.5%), specifically: 5 uretero-vaginal fistula, 3 uroperitoneum, 1 uretero-enteral fistula. There were 3 cases (6.5%) of hydronephrosis at the side of ureteroneocystostomy and 2 cases (4.3%) of unilateral renal impairment requiring nephrectomy. At multivariate analysis only pre-operative radiotherapy (p = 0.047) and a history of pelvic irradiation (p = 0.025) were independently associated with an increased risk of developing severe urinary complications. BPUR is feasible in gynecologic cancer with invasion of the urinary tract. However, since a slight increase of post-operative urological complications was observed in the previously irradiated fields, a personalized surgical planning is recommended for these women in the next future.
Identifiants
pubmed: 32278519
pii: S0748-7983(20)30375-9
doi: 10.1016/j.ejso.2020.03.216
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1366-1372Informations de copyright
Copyright © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of interest statement The authors have nothing to declare.