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

BMC Urology

Research Article

Michael A. O’Donnell¹  Chad R. Tracy¹  Sundeep Deorah¹  Matthew A. Uhlman¹  Amit Gupta¹  James A. Brown¹  Megan T. Bing¹  Kenneth G. Nepple¹  Michael A. Moriarty¹ 

[1] Department of Urology, University of Iowa, 3RCP, 200 Hawkins Drive, 52242, Iowa City, IA, USA;

关键词: Carcinoma;    Intravesical chemotherapy;    Intraoperative mitomycin C;    Nephroureterectomy;    Urothelial carcinoma;   

DOI  :  10.1186/s12894-015-0039-0

 received in 2014-12-08, accepted in 2015-05-19,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundUrothelial 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.MethodsWe 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.ResultsTwenty-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.ConclusionIntraoperative 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.

【 授权许可】

Unknown   
© Moriarty et al.; licensee BioMed Central. 2015. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.