title: HIPEC for peritoneal carcinomatosis: does an associated urologic procedure increase morbidity?
abstract: OBJECTIVE
  To report the incidence of urinary tract procedures performed during complete cytoreductive surgery (CCRS) plus intraperitoneal chemotherapy, and to report the types of procedure, specific morbidity, risk factors, and treatment.
  
  
  METHODS
  Data were extracted from a prospective database of patients with malignant peritoneal disease treated with CCRS plus intraperitoneal chemotherapy who had undergone a resection or suture of the bladder, ureter, or kidney. Patients were eligible whatever the tumor origin.
  
  
  RESULTS
  Between 1994 and 2010, among the 598 patients treated with CCRS plus intraperitoneal chemotherapy, 48 (8%) had undergone a resection or suture in the urinary tract. Procedures included 4 nephrectomies, 19 partial cystectomies, 8 surgically repaired bladder injuries, and 18 ureteral resections. Postoperative mortality was 4% and morbidity was 41%. Specific complications included 6 urinary fistulas (12%), two among the 27 bladder sutures (7%) and four among the 18 ureteral sutures (22%) (P = NS). In the multivariate analysis, the risk factors for urinary fistula were severe preoperative malnutrition (P = 0.05, relative risk [RR] = 7.3) and extensive peritoneal disease (peritoneal cancer index ≥20, P = 0.05, RR = 8.3). Urinary fistulas had been treated nonsurgically in most of the cases.
  
  
  CONCLUSIONS
  Associated urinary tract procedures had occurred in 8% of the cases but did not greatly increase morbidity. Therefore, urinary tract involvement or injury are not contraindications to performing CCRS plus intraperitoneal chemotherapy. Fistulas had complicated only 12% of urinary sutures, mainly in cases of malnutrition or extensive peritoneal disease.
authors.affiliation: Department of Surgical Oncology, Institut Gustave Roussy, Cancer Center, Villejuif, France. chhonore@hotmail.com
authors.forename: C
authors.initials: C
authors.lastname: Honoré
authors.forename: A
authors.initials: A
authors.lastname: Souadka
authors.forename: D
authors.initials: D
authors.lastname: Goéré
authors.forename: F
authors.initials: F
authors.lastname: Dumont
authors.forename: F
authors.initials: F
authors.lastname: Deschamps
authors.forename: D
authors.initials: D
authors.lastname: Elias
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery*; D009367:Neoplasm Staging; D009369:Neoplasms / Q000150:complications* / Q000473:pathology / Q000628:therapy; D010534:Peritoneal Neoplasms / Q000150:complications* / Q000556:secondary / Q000628:therapy; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D014570:Urologic Diseases / Q000601:surgery*; D055815:Young Adult