Intraoperative Mitomycin C Bladder Instillation During Radical Nephroureterectomy Is Feasible and Safe

Autor: Naomi Nadler, Jørgen Bjerggaard Jensen, Kimie Oedorf, Nessn H. Azawi
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: European Urology Open Science
Nadler, N, Oedorf, K, Jensen, J B & Azawi, N 2021, ' Intraoperative Mitomycin C Bladder Installation During Radical Nephroureterectomy Is Feasible and Safe ', European Urology Open Science, vol. 34, pp. 41-46 . https://doi.org/10.1016/j.euros.2021.09.013
European Urology Open Science, Vol 34, Iss, Pp 41-46 (2021)
Nadler, N, Oedorf, K, Jensen, J B & Azawi, N 2021, ' Intraoperative Mitomycin C Bladder Instillation During Radical Nephroureterectomy Is Feasible and Safe ', European Urology Open Science, vol. 34, pp. 41-46 . https://doi.org/10.1016/j.euros.2021.09.013
ISSN: 2666-1683
2666-1691
DOI: 10.1016/j.euros.2021.09.013
Popis: Take Home Message Bladder recurrence after nephroureterectomy is frequent, and the use of adjuvant chemotherapy is advised. In this study, intraoperative intravesical instillation of mitomycin C during radical nephroureterectomy after bladder cuff excision proved to be feasible and did not lead to complications associated with chemotherapy instillation.
Background Bladder recurrence after radical treatment of upper urinary tract urothelial cancer (UTUC) is frequent, and patients are required to undergo surveillance cystoscopies following surgery. The use of intravesical adjuvant chemotherapy is an accepted method to prevent bladder recurrence, but the timing of this method is not standardized and the concept of intraoperative use is unexplored. Objective The objective of the study is to examine the feasibility and safety of intraoperative intravesical mitomycin C (MMC) instillation using a closed-circuit system following bladder cuff excision and bladder closure. Design, setting, and participants All patients who underwent radical nephroureterectomy (RNU) for UTUC at the Department of Urology of Zealand University Hospital, Roskilde, Denmark from 2017 to 2020 were identified. Patient complications within 30 d and data regarding oncological outcome were registered. Outcome measurements and statistical ana lysis Clavien-Dindo grade for complications and descriptive statistics were used. Results During the study period, 64 patients underwent RNU. Of these patients, 49 received bladder instillation of MMC during RNU. Complications were observed in 11 patients (21.4%), where four patients (8.2%) had Clavien-Dindo complication grade (CD) I, four patients (8.2%) had CD II, one patient (2%) had CD III, and one patient (2%) had CD IIIa. None of the complications were suspected to be related to MMC. Five of the 15 patients (33%) who did not receive MMC experienced complications. There were no significant differences in complication rates between patients who received MMC and those who did not. Study limitations include a small sample size and a single-center study. Conclusions Intraoperative vesical instillation of MMC is feasible and was, in the present study, not associated with an increased complication rate. Patient summary Bladder recurrence after radical treatment of upper urinary tract cancer is frequent. The present study findings indicate that intraoperative bladder irrigation with the chemotherapeutic mitomycin C during surgery does not lead to excessive complications and could be a method to reduce the risk of bladder recurrence.
Databáze: OpenAIRE
Externí odkaz: