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Intraoperative urinary tract resection and construction in CRS + HIPEC procedures: a single center retrospective
Zhong-He Ji1,2, Yu-Bin Fu1, Gang Liu1,2
1Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Yangfangdian Street, Haidian District, Beijing, 100038, P. R. China.
Insights
Combining cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) with urinary tract reconstruction is safe, with urinary adverse events not impacting overall survival. Further validation is needed for this complex oncologic procedure.
Area of Science:
- Surgical Oncology
- Oncologic Procedures
- Urinary Tract Surgery
Background:
- The combination of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) with urinary tract resection and reconstruction presents debated safety and efficacy.
- Evaluating this combined approach is crucial for understanding its clinical implications.
Purpose of the Study:
- To summarize clinicopathological features of patients undergoing CRS + HIPEC with urinary tract resection and reconstruction.
- To assess the safety and survival prognosis of this combined surgical technique.
Main Methods:
- Retrospective analysis of 49 patients from a disease-specific database.
- Evaluation of clinicopathological characteristics, perioperative adverse events (AEs), and survival outcomes.
- Kaplan-Meier (K-M) analysis with log-rank comparison for survival data.
Main Results:
- The study included 49 patients, with 22.4% experiencing serious perioperative adverse events (SAEs) and 6.1% experiencing urinary SAEs.
- Urinary adverse events (UAEs) occurred in 46.8% of patients, but did not significantly impact overall survival (OS).
- Median OS was 59.2 months, with no significant difference between patients with or without UAEs (P=0.475).
Conclusions:
- The combination of CRS + HIPEC with urinary tract resection and reconstruction is associated with a high incidence of Grade I-II UAEs, which do not affect OS.
- The safety profile of this combined technique is deemed acceptable.
- Findings require high-level validation due to the retrospective, single-center, single-arm nature of the study.
Introduction:
The safety and efficacy of CRS + HIPEC combined with urinary tract resection and reconstruction are controversial. This study aims to summarize the clinicopathological features and to evaluate the safety and survival prognosis of CRS + HIPEC combined with urinary tract resection and reconstruction.
Methods:
The patients who underwent urinary tract resection and reconstruction as part of CRS surgery were retrospectively selected from our disease-specific database for analysis. The clinicopathological characteristics, treatment-related variables, perioperative adverse events (AEs), and survival outcomes were studied using a descriptive approach and the K-M analysis with log-rank comparison.
Results:
Forty-nine patients were enrolled. Perioperative serious AEs (SAEs) were observed in 11 patients (22.4%), with urinary SAEs occurring in 3 patients (6.1%). Additionally, there were 23 cases (46.8%) involving urinary adverse events (UAEs). The median overall survival (OS) in the entire cohort was 59.2 (95%CI: 42.1-76.4) months. The median OS of the UAE group and No-UAE group were 59.2 months (95%CI not reached), and 50.5 (95%CI: 11.5 to 89.6) months, respectively, with no significant difference (P = 0.475). Furthermore, there were no significant differences in OS based on the grade of UAEs or the number of UAEs (P = 0.562 and P = 0.622, respectively).
Conclusion:
The combination of CRS + HIPEC with urinary tract resection and reconstruction is associated with a high incidence of Grade I-II UAEs, which do not have an impact on OS. The safety profile of this combined technique is acceptable. However, this is a retrospective single-center single-arm analysis, with limitations of generalizability and potential selection bias. The findings need high-level validation.
