Tan Grace Hwei Ching, Shannon Nicholas B, Chia Claramae Shulyn, Lee Lui Shiong, Soo Khee Chee, Teo Melissa Ching Ching
Division of Surgical Oncology, National Cancer Centre Singapore, Singapore.
Duke-NUS Medical School, Singapore.
Asian J Urol. 2018 Jul;5(3):194-198. doi: 10.1016/j.ajur.2017.09.003. Epub 2017 Oct 4.
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are increasingly being used to treat peritoneal malignancies. Urological resections and reconstruction (URR) are occasionally performed during the surgery. We aim to evaluate the impact of these procedures on peri-operative outcomes of CRS and HIPEC patients.
A retrospective review of a prospectively maintained database of all patients who underwent CRS-HIPEC from April 2001 to February 2016 was performed. Outcomes between patients who had surgery involving, and not involving URR were compared. Primary outcomes were the rate of major complications and the duration of stay in the intensive care unit (ICU) and hospital. Secondary outcomes were that of overall survival (OS) and prognostic factors that would indicate a need for URR.
A total of 214 CRS-HIPEC were performed, 21 of which involved a URR. Baseline clinical characteristics did not vary between the groups (URR No URR). Urological resections comprised of 52% bladder resections, 24% ureteric resections, and 24% involving both bladder and ureteric resections. All bladder defects were closed primarily while ureteric reconstructions consisted of two end-to-end anastomoses, one ureto-uretostomy, five direct implantations into the bladder and three boari flaps. URR were more frequently required in patients with colorectal peritoneal disease ( = 0.029), but was not associated with previous pelvic surgery (76% 54%, = 0.065). Patients with URR did not suffer more serious complications (14% 24%, = 0.42). ICU (2.2 days 1.4 days, = 0.51) and hospital stays (18 days 25 days, = 0.094) were not significantly affected. Undergoing a URR did not affect OS ( = 0.99), but was associated with increased operation time (570 min . 490 min, = 0.046).
While concomitant URR were associated with an increase in operation time, there were no significant differences in postoperative complications or OS. Patients with colorectal peritoneal metastases are more likely to require a URR compared to other primary tumours, and needs to be considered during pre-operative planning.
细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC）越来越多地用于治疗腹膜恶性肿瘤。手术期间偶尔会进行泌尿外科切除和重建（URR）。我们旨在评估这些手术对CRS和HIPEC患者围手术期结局的影响。
对2001年4月至2016年2月期间所有接受CRS-HIPEC治疗的患者的前瞻性维护数据库进行回顾性分析。比较了接受涉及URR手术和未涉及URR手术的患者的结局。主要结局是严重并发症发生率、重症监护病房（ICU）住院时间和住院时间。次要结局是总生存期（OS）以及表明需要进行URR的预后因素。
共进行了214例CRS-HIPEC手术，其中21例涉及URR。两组（URR组与无URR组）的基线临床特征无差异。泌尿外科手术包括52%的膀胱切除术、24%的输尿管切除术以及24%的膀胱和输尿管联合切除术。所有膀胱缺损均一期缝合，输尿管重建包括两例端端吻合术、一例输尿管-输尿管吻合术、五例直接植入膀胱术和三例膀胱壁瓣成形术。结直肠腹膜疾病患者更常需要进行URR（P = 0.029），但与既往盆腔手术无关（76%对54%，P = 0.065）。接受URR的患者并未出现更多严重并发症（14%对24%，P = 0.42）。ICU住院时间（2.2天对1.4天，P = 0.51）和住院时间（18天对25天，P = 0.094）未受到显著影响。进行URR并不影响OS（P = 0.99），但与手术时间延长有关（570分钟对490分钟，P = 0.046）。
虽然同期进行URR与手术时间延长有关，但术后并发症或OS并无显著差异。与其他原发性肿瘤相比，结直肠腹膜转移患者更有可能需要进行URR，术前规划时需要考虑这一点。
