Is ureteral stent insertion an initial step for malignant ureteral obstruction in advanced gastric cancer?

Abstract

Objective: We analyzed the relevance of ureteral stents as an initial step for malignant ureteral obstruction (MUO) in advanced gastric cancer (AGC). Background: MUO in AGC compromises survival and decreases the quality of life, yet little is known about the initial management and clinical course of this condition. Methods: We retrospectively reviewed the medical records of 59 patients (118 ureters) who had undergone bilateral retrograde ureteral stent insertion (USI) for MUO due to AGC. We analyzed the following parameters to evaluate the factors affecting success of USI, ureteral stent maintenance (USM), and patient survival in these patients: gender, age, height, weight, initial clinical presentation, Eastern Cooperative Oncology Group (ECOG) performance status, urinalysis, serum creatinine, estimated glomerular filtration rate (GFR), cause and level of obstruction, grade of hydronephrosis, presence of bladder metastasis on computerized tomography, and histological type of gastric cancer. Results: Retrograde USI failed in 29 ureters (24.6%). In USI, upper ureteral obstruction was revealed as an independent risk factor for failure. Among 89 successful insertions, USM failure occurred in 76 ureters (85.4%) median 4.0 days later. Chronic kidney disease (CKD) stages III to V were independent risk factors for a decreased USM period. The median survival of patients with MUO in AGC was 108.0 days (range 4-876), the six-month survival rate was 30.5%, and the one-year survival rate was 13.6%. ECOG performance status ≥ 2, urinary diversion failure and CKD stages III to V were independent risk factors affecting survival. Conclusions: Initial estimated GFR is a strong prognostic factor in both ureteral stent maintenance and patient survival. Patients whose renal function is between CKD stage III and V, initial percutaneous nephrostomy should be strongly considered.