Surgical outcomes of segmental ureteral resection with ureteroneocystostomy after major gynecologic surgery. Issue 7 (July 2020)

• Record Type: Journal Article
• Authors: Federico, Alex; Gallotta, Valerio; Foschi, Nazario; Costantini, Barbara; Conte, Carmine; Pinto, Francesco; Ercoli, Alfredo; Ferrandina, Gabriella; Dal Moro, Fabrizio; Bassi, Pierfrancesco; Zattoni, Filiberto; Scambia, Giovanni; Vizzielli, Giuseppe
• Is Part Of: European journal of surgical oncology. Volume 46:Issue 7(2020)
• Page Start: 1366
• Page End: 1372
• Publication Date: 2020-07
• Subjects: Ureteral resection -- Gynecologic malignancies -- Surgical complications -- Psoas hitch reconstruction -- Personalized surgery; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2020.03.216
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Introduction: Describing the surgical and oncological outcome of bladder-preserving ureter reconstruction (BPUR) with segmental ureteral resection after major gynecologic surgery. Matherials and methods: Patients with BPUR admitted at a single institution between March 2012 and July 2018 were retrospectively analyzed. Surgical and oncological data were assessed. Results: Forty-six women with gynecologic tumors involving the ureter were treated with BPUR. R0 resection was achieved in 40/46 patients (86.9%), while pathologic margins were microscopically positive in 6 women (13.1%). Overall, 12 women (26.0%) received radiotherapy before surgery: among them, 8 patients received neoadjuvant chemoradiotherapy. Twenty-six women underwent BPUR during primary surgery, whereas 20 (43.4%) required BPUR upon recurrence. Twenty-six patients (56.2%) were found to have hydronephrosis at pre-operative workup. The psoas bladder hitch was the most common procedure performed for urinary reconstruction (63%) with respect to direct reimplantation (37%). Fourteen patients (14/46 = 30.4%) experienced urological complications. Urinary leakage occurred in 9 patients (19.5%), specifically: 5 uretero-vaginal fistula, 3 uroperitoneum, 1 uretero-enteral fistula. There were 3 cases (6.5%) of hydronephrosis at the side of ureteroneocystostomy and 2 cases (4.3%) of unilateral renal impairment requiring nephrectomy. At multivariate analysis only pre-operative radiotherapy (p = 0.047) and a history of pelvic irradiation (p = 0.025) were independently associated with an increased risk of developing severe urinary complications. Conclusions: BPUR is feasible in gynecologic cancer with invasion of the urinary tract. However, since a slight increase of post-operative urological complications was observed in the previously irradiated fields, a personalized surgical planning is recommended for these women in the next future.