Reconstruction after ureteral resection during HIPEC surgery: Re-implantation with uretero-neocystostomy seems safer than end-to-end anastomosis

J Visc Surg. 2017 Sep;154(4):227-230. doi: 10.1016/j.jviscsurg.2017.01.002. Epub 2017 Jul 11.

Abstract

Introduction: Resection of the pelvic ureter may be necessary in cytoreductive surgery for peritoneal carcinomatosis in combination with hyperthermic intraperitoneal chemotherapy (HIPEC). As the morbidity for cytoreductive surgery with HIPEC has decreased, expert teams have begun to perform increasingly complex surgical procedures associated with HIPEC, including pelvic reconstructions. After ureteral resection, two types of reconstruction are possible: uretero-ureteral end-to-end anastomosis and uretero-vesical re-implantation or uretero-neocystostomy (the so-called psoas hitch technique). By compiling the experience of three surgical teams that perform HIPEC surgeries, we have tried to compare the effectiveness of these two techniques.

Methodology: A retrospective comparative case-matched multicenter study was conducted for patients undergoing operation between 2005 and 2014. Patients included had undergone resection of the pelvic ureter during cytoreductive surgery with HIPEC for peritoneal carcinomatomosis; ureteral reconstruction was by either end-to-end anastomosis (EEA group) or re-implantation uretero-neocystostomy (RUC group). The primary endpoint was the occurrence of urinary fistula in postoperative follow-up.

Results: There were 14 patients in the EEA group and 14 in the RUC group. The groups were comparable for age, extent of carcinomatosis (PCI index) and operative duration. Four urinary fistulas occurred in the EEA group (28.5%) versus zero fistulas in the RUC group (0%) (P=0.0308).

Conclusion: Re-implantation with uretero-neocystostomy during cytoreductive surgery with HIPEC is the preferred technique for reconstruction after ureteral resection in case of renal conservation.

Keywords: CHIP; HIPEC; Peritoneal carcinomatosis; Ureteral anastomosis; Ureteral re-implantation; Uretero-neocystostomy.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Anastomosis, Surgical
  • Antineoplastic Agents / therapeutic use
  • Chemotherapy, Cancer, Regional Perfusion*
  • Combined Modality Therapy
  • Cystostomy / methods*
  • Cytoreduction Surgical Procedures*
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperthermia, Induced*
  • Male
  • Matched-Pair Analysis
  • Middle Aged
  • Peritoneal Neoplasms / therapy*
  • Reconstructive Surgical Procedures / methods*
  • Retrospective Studies
  • Treatment Outcome
  • Ureter / surgery*

Substances

  • Antineoplastic Agents