Urological approach for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a clinical care center

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is associated with significant manipulation of the urinary tract (UT). We aim to describe the urological events and their management in patients who underwent CRS-HIPEC.

Clinical records of patients who underwent treatment between 2007 and 2015 were reviewed. Urological events and their multidisciplinary management were analyzed. Descriptive statistics were calculated.

A total of 103 patients were included. Mean age was 51 years (SD ± 11.8). Mean peritoneal cancer index (PCI) was 20.4 (SD ± 10.1). Primary tumors included appendicular (64%), gynecological (16%), colorectal (10%), and peritoneal mesotheliomas (9%). Ninety-three percent of patients had bilateral ureteral catheters inserted prior to surgery, without complications. Intraoperative UT injuries occurred in 7% of patients. In 5% of patients, tumor invasion of the bladder was evident at surgery and partial resection and primary repair of the bladder wall was performed. Urological complications included urinary tract infection (UTI) (21%) acute post-renal failure (4%), urinary fistulae (4%), and acute urinary retention (AUR) (1%).

In our study, intraoperative UT events and postoperative complications, although not neglectable, were infrequent. Due to the high complexity of these cases, a multidisciplinary approach is mandatory. However, randomized clinical trials are necessary to clarify current data on the need and efficacy of prophylactic ureteral catheterization in patients undergoing CRS-HIPEC.

Acta chirurgica Belgica. 2018 Feb 23 [Epub ahead of print]

Carlos Gustavo Trujillo, Cristina Domínguez, Daniela Robledo, Juan Ignacio Caicedo, Alejandra Bravo-Balado, Juan Guillermo Cataño, Natalia Cortés, Lina Parra, Wilson Riaño, Eduardo Londoño-Schimmer, Jorge Otero, Gabriel Herrera, Fernando Arias, Mauricio Plata

a Department of Urology , Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine , Bogotá , Colombia., b Department of Surgery, Hospital Universitario Fundación Santa Fe de Bogotá , Bogotá , Colombia., c Clinical Care Center for Peritoneal Neoplasms , Hospital Universitario Fundación Santa Fe de Bogotá , Bogotá , Colombia.