Düzgün Özgül, Kalın Murat, Sobay Resul, Özkan Ömer Faruk
Department of General Surgery, Health Sciences University, Umraniye Research and Education Hospital, Istanbul, Turkey.
Department of General Surgery, Health Sciences University,Umraniye Research and Education Hospital, İstanbul,Turkey.
Ther Adv Urol. 2020 Dec 10;12:1756287220975923. doi: 10.1177/1756287220975923. eCollection 2020 Jan-Dec.
Urinary system resections and reconstructions are needed in peritoneal carcinomatosis due to abdominal malignancies. The effect of hyperthermic intraperitoneal chemotherapy on these urological procedures after reconstruction remains uncertain. The aim of the study is to evaluate major urological interventions during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in complex abdominal malignancies with peritoneal carcinomatosis.
Forty-four cases underwent surgical intervention related to the urinary system among 208 cases who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy because of peritoneal carcinomatosis. Urinary system procedures performed in these patients (radical-partial cystectomy, partial ureter resection ureteroneocystostomy, ureteroureterostomy, nephrectomy) were evaluated in terms of postoperative morbidity-mortality and survival.
Urinary system resections were performed during cytoreductive surgery in a total of 44 cases. The mean age was 54 years (20-73). Patients were diagnosed with peritoneal carcinomatosis due to colorectal cancer in 21 (47.8%), ovarian cancer in nine (20.4%), sarcomatosis in five (11.4%), cervical cancer in four (9%) and other cancers (mesothelioma, uterus, breast, gastric) in five (11.4%) cases. Total nephrectomy was performed in three cases and partial nephrectomy in one case. Cystectomy was performed in 21 cases; 16 of these were partial and five were total cystectomies. Ureteroureterocystostomy with double J was performed in four cases and ureteroneocystostomy in 12 cases. While Clavian-Dindo grade 3-4 complications were seen in nine cases (20.4%), three cases (6.8%) became exitus during the first 30-day follow-up.
Although urinary system involvements have been regarded as inoperable in the past, we think that with adequate experience radical urinary interventions performed in suitable patients can be carried out with acceptable morbidity and mortality as seen in our series.
腹部恶性肿瘤导致的腹膜癌患者需要进行泌尿系统切除和重建手术。热灌注化疗对重建后这些泌尿外科手术的影响仍不确定。本研究的目的是评估在伴有腹膜癌的复杂腹部恶性肿瘤的细胞减灭术和热灌注化疗期间的主要泌尿外科干预措施。
在208例因腹膜癌接受细胞减灭术和热灌注化疗的患者中，44例接受了与泌尿系统相关的手术干预。对这些患者所进行的泌尿系统手术（根治性部分膀胱切除术、部分输尿管切除术输尿管膀胱吻合术、输尿管输尿管吻合术、肾切除术）的术后发病率、死亡率和生存率进行了评估。
在细胞减灭术中总共对44例患者进行了泌尿系统切除。平均年龄为54岁（20 - 73岁）。患者中，21例（47.8%）因结直肠癌诊断为腹膜癌，9例（20.4%）因卵巢癌，5例（11.4%）因肉瘤病，4例（9%）因宫颈癌，5例（11.4%）因其他癌症（间皮瘤、子宫、乳腺、胃）。3例行全肾切除术，1例行部分肾切除术。21例行膀胱切除术；其中16例为部分膀胱切除术，5例为全膀胱切除术。4例行双J管输尿管输尿管膀胱吻合术，12例行输尿管膀胱吻合术。9例（20.4%）出现Clavian - Dindo 3 - 4级并发症，3例（6.8%）在术后30天随访期间死亡。
尽管过去认为泌尿系统受累无法手术，但我们认为，凭借足够的经验，在合适的患者中进行根治性泌尿外科干预，其发病率和死亡率是可以接受的，如我们系列研究所示。
