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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Urology 1/2015

Evaluating the safety of intraoperative instillation of intravesical chemotherapy at the time of nephroureterectomy

Zeitschrift:
BMC Urology > Ausgabe 1/2015
Autoren:
Michael A. Moriarty, Matthew A. Uhlman, Megan T. Bing, Michael A. O’Donnell, James A. Brown, Chad R. Tracy, Sundeep Deorah, Kenneth G. Nepple, Amit Gupta
Wichtige Hinweise
Matthew A. Uhlman contributed equally to this work.

Competing interests

The authors declare that they have no competing interests.

Author’s contributions

MM participated in project design and development, data collection/management, and manuscript writing/editing. MU participated in project design and development, data collection/management, data analysis, and manuscript writing/editing. MB participated in project design and development, and manuscript writing/editing. MO participated in project design and development, and manuscript writing/editing. JB participated in project design and development, and manuscript writing/editing. CT participated in project design and development, and manuscript writing/editing. SD participated in project design and development, and manuscript writing/editing. KN participated in project design and development, and manuscript writing/editing. AG participated in project design and development, data collection/management, data analysis, and manuscript writing/editing. All authors read, edited and approved the final version of the manuscript.

Abstract

Background

Urothelial carcinoma (UC) is a common cancer affecting many patients in the United States. Nephroureterectomy remains the gold standard for the treatment of high grade upper tract disease or low grade tumors that are not amenable to endoscopic management. Recent reports have shown a decrease in UC recurrence in patients who underwent nephroureterectomy and who had Mitomycin C (MMC) instilled into the bladder at the time of catheter removal. At our institution instillation of intravesical MMC at the time of nephroureterectomy has been common for more than 10 years. Given the recent data, we sought to formally describe our experience with and evaluate the safety of intravesical instillation of cytotoxic chemotherapy at the time of nephroureterectomy.

Methods

We retrospectively reviewed 51 patients who underwent intraoperative intravesical instillation of cytotoxic chemotherapy (MMC (n = 48) or adriamycin (n = 3)) at the time of nephroureterectomy (2000–2012). The procedure was performed in a similar fashion by 8 different surgeons from the same institution, with drainage of the bladder prior to management of the bladder cuff. Patient characteristics and perioperative data including complications out to 90 days after surgery were collected. Perioperative complications for all patients were graded using the modified Clavien-Dindo classification.

Results

Twenty-four men and 27 women underwent intraoperative intravesical instillation of cytotoxic chemotherapy at the time of nephroureterectomy. Median age at the time of operation was 74 years (range 48–88). Median dwell time was 60 min. Twenty three patients had a total of 45 perioperative complications. The majority (36/45) were Clavien grades I and II. No patients experienced any intraoperative or postoperative complications attributable to MMC or Adriamycin instillation.

Conclusion

Intraoperative intravesical instillation of cytotoxic chemotherapy at the time of nephroureterectomy is safe and feasible. Multicenter trials to study the efficacy of early cytotoxic chemotherapy administration to prevent recurrence of bladder urothelial carcinoma following nephroureterectomy are warranted.
Literatur
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