Ureteral Stenting in Cytoreductive Surgery plus Hyperthermic Intraperitoneal Chemotherapy as a Routine Procedure: Evidence and NecessityCoccolini F. · Lotti M. · Manfredi R. · Catena F. · Vallicelli C. · De Iaco P.A. · Da Pozzo L. · Frigerio L. · Ansaloni L.
Departments of aGeneral and Emergency Surgery, bUrology, and cObstetrics and Gynecology, Ospedali Riuniti, Bergamo, and Departments of dGeneral and Transplant Surgery, and eObstetrics and Gynecology, Sant’Orsola-Malpighi University Hospital, Bologna, Italy
Introduction: There is a need for more exhaustive data concerning the use of prophylactic ureteral stenting for extended debulking and cytoreductive procedures in the literature. Material and Methods: A retrospective analysis of the CARPEPACEM study protocol database was performed. The trial protocol schedules the positioning of bilateral ureteral stents before cytoreductive surgery + hyperthermic intraperitoneal chemotherapy (HIPEC). Results: Fifty-one operated patients: 31 (59.6%) with peritoneal dissemination from ovarian cancer, 8 (15.3%) from colorectal cancer, 4 (7.9%) from pseudomyxoma peritonei, 3 (5.7%) from gastric cancer, 2 (3.8%) from peritoneal mesothelioma, 1 (1.9%) from appendiceal cancer, 1 (1.9%) from endometrial cancer, and 1 (1.9%) from leiomyosarcoma. Mean and median peritoneal cancer index: 11 and 10 (range: 0–28). CC-score: CC-0 in 45 (86.5%) patients, CC-1 in 5 (9.6%) and CC-2 in 1 (1.9%). HIPEC was performed with platinum + taxol in 22 patients (42.3%), platinum + adriablastin in 10 (19.2%), mitomycin in 9 (17.3%), platinum + mitomycin in 7 (13.4%), platinum + doxorubicin in 2 (3.8%), and taxol + adriablastin in 1 (1.9%). Two major ureteral complications were observed (3.9%). Discussion: Prophylactic ureteral stenting could reduce the risk of postoperative ureteral complications without an increase in stent placement-related complications; however, a randomized clinical trial is needed.
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