Walker Dyvon T, Flores Hunter A, Bhalla Rohan G, Higgins Margaret M, Franco Salvador Rodriguez, Jauregui Rebeca Gonzalez, Flynn Brian J, Ahrendt Steven A, Higuchi Ty T
Department of Surgery, Division of Urology, University of Colorado Anschutz School of Medicine, 12631 E. 17th Ave., Mail Stop C-319, Aurora, CO, 80045, USA.
Department of Surgery, Division of Surgical Oncology, University of Colorado Anschutz School of Medicine, Aurora, CO, USA.
Int Urol Nephrol. 2025 Sep 16. doi: 10.1007/s11255-025-04782-x.
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is a cornerstone treatment for resectable peritoneal carcinomatosis. Urologic reconstructive surgery is required in 7-20% of cytoreductive surgeries due to urinary tract involvement or injury, yet current literature on outcomes remains limited. This study presents one of the largest single-institution cohorts examining outcomes of urologic reconstruction in CRS/HIPEC cases, and is the first to investigate the impact of preoperative planning and intraoperative timing of urologic reconstruction on postoperative outcomes.
A retrospective analysis of 314 cases was performed from June 2010 to August 2023. Data from cases involving urologic reconstruction were analyzed, including demographics, surgical details, and outcomes. Statistical analyses evaluated associations between surgical variables and short and long-term urologic complications.
Urologic reconstruction was performed in 35 cases (11.1%), with the majority occurring after HIPEC administration. Postoperative urologic complications occurred in 57% of cases. 40% of the urologic reconstruction cases resulted in low-grade, short-term urologic complications (AKI, UTI) while 20% were deemed high-grade (sepsis, urine leak). 29% developed long-term sequelae such as ureteral stricture or urinary retention. Longer operative times were significantly associated with long-term complications. No significant differences were found in long-term complication rates based on the timing of urologic repair (pre-HIPEC or post-HIPEC) or whether urologic intervention was planned prior to surgery. Interestingly, there was a significant association between fewer prior abdominal surgeries and higher complication rates.
Surgical complexity and prior surgical history are key determinants of postoperative outcomes following urologic reconstruction at the time of cytoreductive surgery. Timing of urologic intervention and specific preoperative variables, such as age and peritoneal cancer index score, did not significantly impact long-term outcomes. Higher complication rates were also seen among patients with fewer prior abdominal surgeries, which may in part be due to selection bias or other unaccounted variables present in the patients with fewer abdominal surgeries. These findings highlight the importance of individualized surgical planning and inform preoperative discussions about the risks and benefits of CRS with HIPEC.
细胞减灭术联合热灌注化疗（HIPEC）是可切除性腹膜癌病的基石性治疗方法。由于尿路受累或损伤，在7%至20%的细胞减灭术中需要进行泌尿外科重建手术，但目前关于其预后的文献仍然有限。本研究展示了最大的单机构队列研究之一，该研究考察了CRS/HIPEC病例中泌尿外科重建的预后情况，并且是首个探究泌尿外科重建的术前规划和术中时机对术后预后影响的研究。
对2010年6月至2023年8月期间的314例病例进行回顾性分析。分析了涉及泌尿外科重建病例的数据，包括人口统计学资料、手术细节和预后情况。统计分析评估了手术变量与短期和长期泌尿外科并发症之间的关联。
35例（11.1%）患者进行了泌尿外科重建，大多数发生在热灌注化疗之后。57%的病例出现了术后泌尿外科并发症。40%的泌尿外科重建病例导致了低级别短期泌尿外科并发症（急性肾损伤、尿路感染），而20%被认为是高级别并发症（脓毒症、尿漏）。29%的患者出现了输尿管狭窄或尿潴留等长期后遗症。手术时间越长与长期并发症显著相关。基于泌尿外科修复时机（热灌注化疗前或热灌注化疗后）或泌尿外科干预是否在手术前计划进行，长期并发症发生率未发现显著差异。有趣的是，既往腹部手术次数较少与较高的并发症发生率之间存在显著关联。
手术复杂性和既往手术史是细胞减灭术时泌尿外科重建术后预后的关键决定因素。泌尿外科干预的时机和特定的术前变量，如年龄和腹膜癌指数评分，对长期预后没有显著影响。既往腹部手术次数较少的患者并发症发生率也较高，这可能部分归因于选择偏倚或腹部手术次数较少患者中存在的其他未考虑到的变量。这些发现凸显了个体化手术规划的重要性，并为关于CRS联合HIPEC风险和益处的术前讨论提供了参考。
