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Clinical Outcomes After Urinary Diversion for Malignant Ureteral Obstruction Secondary to Non-urologic Cancer: An Analysis of 778 Cases

 Ji Eun Heo  ;  Dae Young Jeon  ;  Jongsoo Lee  ;  Won Sik Ham  ;  Young Deuk Choi  ;  Won Sik Jang 
 ANNALS OF SURGICAL ONCOLOGY, Vol.28(4) : 2367-2373, 2021-04 
Journal Title
Issue Date
Humans ; Male ; Neoplasms* / complications ; Nephrostomy, Percutaneous* / adverse effects ; Retrospective Studies ; Stents ; Ureter* ; Ureteral Obstruction* / etiology ; Ureteral Obstruction* / surgery ; Urinary Diversion* / adverse effects
Background: This study investigated patient outcomes after urinary diversion in order to manage malignant ureteral obstruction caused by non-urologic cancers and to evaluate predictive factors for overall survival.

Methods: The study retrospectively reviewed patients with non-urologic malignancies who underwent ureteral stenting or percutaneous nephrostomy for ureteral obstruction between 2006 and 2014. The variables for predicting overall survival were identified by Cox regression analysis.

Results: The study enrolled 778 patients, including 522 patients who underwent ureteral stenting and 256 patients who underwent percutaneous nephrostomy. Renal function was assessed immediately and then 2 weeks after urinary diversion. The median survival period was 5 months (interquartile range [IQR] 2-12 months). A total of 708 patients died. The patients who received chemotherapy after urinary diversion had a survival gain of 7 months compared with the patients who did not receive subsequent chemotherapy (p < 0.001). The survival rate did not differ between the various types of urinary diversion (p = 0.451). In the multivariate analysis, lower survival rates were significantly associated with male sex; previous chemotherapy without radiotherapy; an increasing number of events related to malignant dissemination; low preoperative hemoglobin (< 10 mg/dL), albumin (< 3 g/dL), and estimated glomerular filtration (< 60 mL/min/1.73 m2) rates; and no subsequent chemotherapy or radiotherapy.

Conclusions: In cases of ureteral obstruction caused by non-urologic malignancies, the overall survival was poor. However, the patients who received chemotherapy after urinary diversion had a survival gain of 7 months. Therefore, urinary diversion could be considered to preserve renal function for subsequent chemotherapy, whereas patients with the poor prognostic factors should be presented with the option of no intervention.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Lee, Jong Soo(이종수) ORCID logo https://orcid.org/0000-0002-9984-1138
Jang, Won Sik(장원식) ORCID logo https://orcid.org/0000-0002-9082-0381
Choi, Young Deuk(최영득) ORCID logo https://orcid.org/0000-0002-8545-5797
Ham, Won Sik(함원식) ORCID logo https://orcid.org/0000-0003-2246-8838
Heo, Ji Eun(허지은) ORCID logo https://orcid.org/0000-0002-4184-8468
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