Trujillo Carlos Gustavo, Domínguez Cristina, Robledo Daniela, Caicedo Juan Ignacio, Bravo-Balado Alejandra, Cataño Juan Guillermo, Cortés Natalia, Parra Lina, Riaño Wilson, Londoño-Schimmer Eduardo, Otero Jorge, Herrera Gabriel, Arias Fernando, Plata Mauricio
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.
Acta Chir Belg. 2018 Dec;118(6):348-353. doi: 10.1080/00015458.2018.1436797. Epub 2018 Feb 23.
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.
细胞减灭术和热灌注化疗（CRS-HIPEC）与对尿路（UT）的显著操作有关。我们旨在描述接受CRS-HIPEC治疗的患者的泌尿系统事件及其处理方法。
回顾了2007年至2015年间接受治疗的患者的临床记录。分析了泌尿系统事件及其多学科处理方法。计算了描述性统计数据。
共纳入103例患者。平均年龄为51岁（标准差±11.8）。平均腹膜癌指数（PCI）为20.4（标准差±10.1）。原发肿瘤包括阑尾（64%）、妇科（16%）、结直肠（10%）和腹膜间皮瘤（9%）。93%的患者在手术前插入了双侧输尿管导管，无并发症。7%的患者术中发生尿路损伤。5%的患者在手术中可见膀胱肿瘤侵犯，并行膀胱壁部分切除和一期修复。泌尿系统并发症包括尿路感染（UTI）（21%）、急性肾后性肾衰竭（4%）、尿瘘（4%）和急性尿潴留（AUR）（1%）。
在我们的研究中，术中尿路事件和术后并发症虽然不可忽视，但并不常见。由于这些病例的高度复杂性，多学科方法是必不可少的。然而，需要进行随机临床试验以阐明目前关于接受CRS-HIPEC治疗的患者预防性输尿管插管的必要性和疗效的数据。
