Abstract:

Objective: This study aimed to investigate the early and late outcomes of simultaneous urological procedures performed in patients who underwent surgery for primary or recurrent colorectal cancers with locally advanced disease or peritoneal metastases and effects of resection and reconstruction of the ureter and bladder on survival. Materials and Methods: All patients with locally advanced disease or peritoneal metastases requiring concurrent urological procedures in our clinic between January 2014 and December 2020 were evaluated for this study. Only patients with bladder and ureter intervention were included in the study. Postoperative complications and urological complications were evaluated and classified according to the Clavien-Dindo classification. Imaging studies, interventional procedures, and follow-ups of patients with problems related to the urinary system in the long-term were recorded. The survival times of the patients were investigated. Results: A total of 52 patients underwent simultaneous urological resection (ureter and bladder). As a synchronous urological procedure, an end-to-end anastomosis was performed after ureter resection in 12 patients, transureter anastomosis to 4, partial cystectomy in 20, ileal conduit with total cystectomy in 7, orthotropic neobladder in 1, and ureteroneocystostomy in 8. The most common early complication in all patients was urinary leakage (10 patients), followed by wound infection (6 patients). The shortest and longest follow-up period of the whole group was 8 and 78 months, respectively, and the mean survival time was 38 months. No difference was found between patients with malignant ureter and benign ureter resections in terms of survival (p=0.888). Conclusion: In patients with clinical T4b and colorectal malignancies, en bloc resection should be the oncological procedure for bladder resections; if possible, organ-preserving surgery should be performed with sufficient negative margin. However, it is thought that the late outcomes of ureteroneocystostomy in ureter reconstruction are better and those of total cystectomy procedure are worse.

Keywords: