Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, Timone Hospital, Aix Marseille University, Marseille, France.
Department of Digestive Surgery, Cancer Institute of Montpellier, Montpellier, France.
Colorectal Dis. 2023 Jul;25(7):1433-1445. doi: 10.1111/codi.16630. Epub 2023 May 30.
The long-term urological sequelae after iatrogenic ureteral injury (IUI) during colorectal surgery are not clearly known. The aims of this work were to report the incidence of IUI and to analyse the long-term consequences of urological late complications and their impact on oncological results of IUI occurring during colorectal surgery through a French multicentric experience (GRECCAR group).
All the patients who presented with IUI during colorectal surgery between 2010 and 2019 were retrospectively included. Patients with ureteral involvement needing en bloc resection, delayed ureteral stricture or noncolorectal surgery were not considered.
A total of 202 patients (93 men, mean age 63 ± 14 years) were identified in 29 centres, corresponding to 0.32% of colorectal surgeries (n = 63 562). Index colorectal surgery was mainly oncological (n = 130, 64%). IUI was diagnosed postoperatively in 112 patients (55%) after a mean delay of 11 ± 9 days. Intraoperative diagnosis of IUI was significantly associated with shorter length of stay (21 ± 22 days vs. 34 ± 22 days, p < 0.0001), lower rates of postoperative hydronephrosis (2% vs. 10%, p = 0.04), anastomotic complication (7% vs. 22.5%, p = 0.002) and thromboembolic event (0% vs. 6%, p = 0.02) than postoperative diagnosis of IUI. Delayed chemotherapy because of IUI was reported in 27% of patients. At the end of the follow-up [3 ± 2.6 years (1 month-13 years)], 72 patients presented with urological sequalae (36%). Six patients (3%) required a nephrectomy.
IUI during colorectal surgery has few consequences for the patients if recognized early. Long-term urological sequelae can occur in a third of patients. IUI may affect oncological outcomes in colorectal surgery by delaying adjuvant chemotherapy, especially when the ureteral injury is not diagnosed peroperatively.
医源性输尿管损伤（IUI）后长期的泌尿系统后遗症尚不清楚。本研究旨在通过法国多中心经验（GRECCAR 组）报道在结直肠手术中发生的 IUI 的发生率，并分析泌尿系统晚期并发症的长期后果及其对 IUI 的肿瘤学结果的影响。
回顾性纳入 2010 年至 2019 年期间在结直肠手术中发生 IUI 的所有患者。未考虑需要整块切除、延迟性输尿管狭窄或非结直肠手术的输尿管受累患者。
共 29 个中心确定了 202 例患者（93 例男性，平均年龄 63±14 岁），占结直肠手术的 0.32%（n=63562）。主要为肿瘤学的指数结直肠手术（n=130，64%）。112 例（55%）患者在术后平均 11±9 天后诊断为 IUI。术中诊断的 IUI 与较短的住院时间（21±22 天与 34±22 天，p<0.0001）、较低的术后肾积水发生率（2%与 10%，p=0.04）、吻合口并发症发生率（7%与 22.5%，p=0.002）和血栓栓塞事件发生率（0%与 6%，p=0.02）显著相关。由于 IUI 而延迟化疗的报告率为 27%。在随访结束时（3±2.6 年（1 个月至 13 年）），72 例患者出现泌尿系统后遗症（36%）。6 例（3%）患者需要肾切除术。
如果能早期发现，结直肠手术中的 IUI 对患者的影响较小。三分之一的患者可能会出现长期的泌尿系统后遗症。IUI 可能会通过延迟辅助化疗来影响结直肠手术的肿瘤学结果，特别是当输尿管损伤未在术中诊断时。
