Routine prophylactic ureteral stenting before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Safety and usefulness from a single-center experience

Özet

Objective:There are very few evidences about safety and usefulness of routine prophylactic ureteral stent- ing (PUS) before cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).Materialandmethods:AnanalysisofprospectivelycollecteddataaboutpatientswhounderwentCRSand HIPEC for different sites ofprimarydisease wascarriedout focusing on ureteralcomplications.Results:A total of138patients who underwent CRS and HIPEC between December2010and June2017wereconsidered.AllpatientsunderwentPUSbeforeCRSandHIPEC.Ofthem,91(66.4%)patientsreceived pelvicperitonectomy,49(35.8%)pelviclymphadenectomy,31(22.6%)lefthemicolectomy,44(32.4%)righthemicolectomy, 46(33.6%)rectal resection, 56(40.9%)hysteroannessiectomy, and 39(28.5%)appendec-tomy.Therewasone(0.7%)postoperativeureteralfistula.Thecumulativeriskofureteralstent-relatedmajor complications was4.3% (twopatients(1.4%)had protracted gross hematuria, two patients(1.4%)had uri-narysepsis,andthreepatients(2.9%)developedhydronephrosisafteraperiodfromremovingureteralstents andrequiredrestenting.Morbidityduetoureteralstentingwasassociatedwithalongerlengthofstay(LOS) (p=0.053). A total of52patients(44.1%)developed renal dysfunction according to theRIFLE(Risk, Injury, Failure,Lossofkidneyfunction,End-stagekidney-disease)criteria:19.5%wereinriskclass,10.2%inacute renal injury class, and14.4%in acute renal failureclass.Conclusion:PUS could be a useful tool for reducing iatrogenic ureteral injury, but it is associated with a non-negligiblemorbidity,whichimplieslongerLOS.AmoreaccuratepatientselectionforPUSisnecessary.