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Impact of Concomitant Urologic Intervention on Clinical Outcomes After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Saxena, Akshat, MBBS, BMedSc; Liauw, Winston, MBBS; Virk, Sohaib A., BSc(Med); Morris, David L., MBBS, MD, PhD

American Journal of Clinical Oncology: October 2018 - Volume 41 - Issue 10 - p 943–948
doi: 10.1097/COC.0000000000000414
Original Articles: Gynecologic

Introduction: The impact of concomitant urologic procedures (UPs) on perioperative and long-term outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is uncertain.

Methods: In total, 935 consecutive CRS/HIPEC procedures were performed between 1996 and 2016 in Sydney, Australia. Among these, 73 (7.8%) involved concomitant UP. The association of concomitant UP with 21 perioperative outcomes and overall survival was assessed using univariate and multivariate analyses.

Results: In-hospital mortality was 1.8%. Patients requiring UP were more likely to require transfusion of ≥5 units of red blood cells (P=0.031) and have a complete cytoreduction (79% vs. 60%, P<0.001). On multivariate analysis, UP was not associated with in-hospital mortality (2.7% vs. 1.7%, P=0.407) or grade III/IV morbidity (52% vs. 41%, P=0.376). The incidence of ureteric fistula (4% vs. 1%, P=0.004), return to theater (26% vs. 14%, P=0.005) and digestive fistula (22% vs. 11%, P=0.005) was higher in the UP group. The addition of a UP did not significantly impact overall survival for appendiceal cancer (P=0.162), colorectal cancer (P=0.315), or pseudomyxoma peritonei (P=0.120).

Conclusions: Addition of a UP was not associated with an increased risk of grade III/IV morbidity or poorer long-term survival after CRS/HIPEC.

UNSW Department of Surgery, St George Hospital, Kogarah, NSW, Australia

The authors declare no conflicts of interest.

Reprints: Akshat Saxena, MBBS, BMedSc, UNSW Department of Surgery, St George Hospital, Level 3, Pitney Building, Kogarah, 2217, New South Wales, Australia. E-mail:

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