title: Ureteral stenting in cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy as a routine procedure: evidence and necessity.
abstract: BACKGROUND
  There is a need for more exhaustive data concerning the use of prophylactic ureteral stenting for extended debulking and cytoreductive procedures in the literature.
  
  
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General and Emergency Surgery, Ospedali Riuniti, Bergamo, Italy. fedecocco@iol.it
authors.forename: Federico
authors.initials: F
authors.lastname: Coccolini
authors.forename: Marco
authors.initials: M
authors.lastname: Lotti
authors.forename: Roberto
authors.initials: R
authors.lastname: Manfredi
authors.forename: Fausto
authors.initials: F
authors.lastname: Catena
authors.forename: Carlo
authors.initials: C
authors.lastname: Vallicelli
authors.forename: Pier Andrea
authors.initials: PA
authors.lastname: De Iaco
authors.forename: Luigi
authors.initials: L
authors.lastname: Da Pozzo
authors.forename: Luigi
authors.initials: L
authors.lastname: Frigerio
authors.forename: Luca
authors.initials: L
authors.lastname: Ansaloni
mesh_terms: D000328:Adult; D000368:Aged; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D012306:Risk; D015607:Stents; D014513:Ureter / Q000473:pathology*; D013520:Urologic Surgical Procedures / Q000379:methods*