Outcome of palliative urinary diversion in the treatment of advanced malignancies
BACKGROUND It is unclear whether palliative endourologic or percutaneous urinary diversion in the treatment of advanced cancer provides significant improvement in quality or duration of life. The purpose of this study was to evaluate survival and performance status after endourologic palliative urin...
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| Veröffentlicht in: | Cancer 1999-02, Vol.85 (4), p.998-1003 |
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| creator | Shekarriz, Bijan Shekarriz, Hodjat Upadhyay, Jyoti Banerjee, Mousumi Becker, Herman Edson Pontes, J. Wood, David P. |
| description | BACKGROUND
It is unclear whether palliative endourologic or percutaneous urinary diversion in the treatment of advanced cancer provides significant improvement in quality or duration of life. The purpose of this study was to evaluate survival and performance status after endourologic palliative urinary diversion in patients with advanced malignancy and to compare the results for different malignancies.
METHODS
One hundred three patients with advanced malignancies underwent palliative urinary diversion (stent or nephrostomy) between 1986 and 1997. Ninety‐two patients and 11 patients had bilateral and unilateral obstruction, respectively. Indications, complications, performance status after diversion, and survival for patients with different malignancies were identified and compared. A modified Karnofsky performance scale (KPS) was used for assessment of physical performance. A scale of 0–4 was used: 0) hospitalized until death; 1) bedridden at home, severe pain despite analgesia; 2) moderate disability, moderate pain despite analgesia; 3) mild disability, pain free with medication; and 4) normal.
RESULTS
The mean age of patients was 68 years. The mean pre‐ and postoperative creatinine levels were 6 mg/dL and 3.3 mg/dL, respectively (P < 0.0001). The median survival and days of hospitalization were 112 and 45, respectively. The median postdiversion KPS score was 2 (range, 0–4), and 15% of patients never left the hospital. Overall, 51% required secondary percutaneous procedures, and 68.4% had complications (minor, 63%; major, 5.4%).
CONCLUSIONS
Most patients with advanced cancers had poor performance status and survival after diversion. Eighty six percent had cancer‐related symptoms despite the diversion. The average survival was 5 months, 50% of which was spent in the hospital. Primary endourologic procedures had a high failure rate, and additional procedures were required. Cancer 1999;85:998–1003. © 1999 American Cancer Society.
Endourologic management of malignant ureteral obstruction has a high surgical failure and complication rate. Furthermore, palliative urinary diversion is associated with poor prognosis in terms of survival and performance status after diversion, regardless of the type of malignancy. |
| doi_str_mv | 10.1002/(SICI)1097-0142(19990215)85:4<998::AID-CNCR30>3.0.CO;2-F |
| format | Article |
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It is unclear whether palliative endourologic or percutaneous urinary diversion in the treatment of advanced cancer provides significant improvement in quality or duration of life. The purpose of this study was to evaluate survival and performance status after endourologic palliative urinary diversion in patients with advanced malignancy and to compare the results for different malignancies.
METHODS
One hundred three patients with advanced malignancies underwent palliative urinary diversion (stent or nephrostomy) between 1986 and 1997. Ninety‐two patients and 11 patients had bilateral and unilateral obstruction, respectively. Indications, complications, performance status after diversion, and survival for patients with different malignancies were identified and compared. A modified Karnofsky performance scale (KPS) was used for assessment of physical performance. A scale of 0–4 was used: 0) hospitalized until death; 1) bedridden at home, severe pain despite analgesia; 2) moderate disability, moderate pain despite analgesia; 3) mild disability, pain free with medication; and 4) normal.
RESULTS
The mean age of patients was 68 years. The mean pre‐ and postoperative creatinine levels were 6 mg/dL and 3.3 mg/dL, respectively (P < 0.0001). The median survival and days of hospitalization were 112 and 45, respectively. The median postdiversion KPS score was 2 (range, 0–4), and 15% of patients never left the hospital. Overall, 51% required secondary percutaneous procedures, and 68.4% had complications (minor, 63%; major, 5.4%).
CONCLUSIONS
Most patients with advanced cancers had poor performance status and survival after diversion. Eighty six percent had cancer‐related symptoms despite the diversion. The average survival was 5 months, 50% of which was spent in the hospital. Primary endourologic procedures had a high failure rate, and additional procedures were required. Cancer 1999;85:998–1003. © 1999 American Cancer Society.
Endourologic management of malignant ureteral obstruction has a high surgical failure and complication rate. Furthermore, palliative urinary diversion is associated with poor prognosis in terms of survival and performance status after diversion, regardless of the type of malignancy.</description><identifier>ISSN: 0008-543X</identifier><identifier>EISSN: 1097-0142</identifier><identifier>DOI: 10.1002/(SICI)1097-0142(19990215)85:4<998::AID-CNCR30>3.0.CO;2-F</identifier><identifier>PMID: 10091780</identifier><identifier>CODEN: CANCAR</identifier><language>eng</language><publisher>New York: John Wiley & Sons, Inc</publisher><subject>Aged ; Biological and medical sciences ; Biomarkers - blood ; Creatinine - blood ; Female ; Hospitalization - statistics & numerical data ; Humans ; Hydronephrosis - blood ; Hydronephrosis - etiology ; Hydronephrosis - surgery ; Karnofsky Performance Status ; Male ; malignancy ; malignant ureteral obstruction ; Medical sciences ; Neoplasm Staging ; Neoplasms - blood ; Neoplasms - complications ; Neoplasms - pathology ; Neoplasms - therapy ; Nephrostomy, Percutaneous ; Palliative Care ; palliative urinary diversion ; percutaneous nephrostomy ; Quality of Life ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the urinary system ; Survival Analysis ; Treatment Outcome ; Ureteral Obstruction - blood ; Ureteral Obstruction - etiology ; Ureteral Obstruction - surgery ; ureteral stent ; Urinary Diversion</subject><ispartof>Cancer, 1999-02, Vol.85 (4), p.998-1003</ispartof><rights>Copyright © 1999 American Cancer Society</rights><rights>1999 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c5460-d3c98c4894e6fa2eed2e94a85ca2712d1f1e48647b0794948ac9cb88e0718e73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2F%28SICI%291097-0142%2819990215%2985%3A4%3C998%3A%3AAID-CNCR30%3E3.0.CO%3B2-F$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2F%28SICI%291097-0142%2819990215%2985%3A4%3C998%3A%3AAID-CNCR30%3E3.0.CO%3B2-F$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>309,310,314,776,780,785,786,1411,1427,23909,23910,25118,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1757994$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10091780$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shekarriz, Bijan</creatorcontrib><creatorcontrib>Shekarriz, Hodjat</creatorcontrib><creatorcontrib>Upadhyay, Jyoti</creatorcontrib><creatorcontrib>Banerjee, Mousumi</creatorcontrib><creatorcontrib>Becker, Herman</creatorcontrib><creatorcontrib>Edson Pontes, J.</creatorcontrib><creatorcontrib>Wood, David P.</creatorcontrib><title>Outcome of palliative urinary diversion in the treatment of advanced malignancies</title><title>Cancer</title><addtitle>Cancer</addtitle><description>BACKGROUND
It is unclear whether palliative endourologic or percutaneous urinary diversion in the treatment of advanced cancer provides significant improvement in quality or duration of life. The purpose of this study was to evaluate survival and performance status after endourologic palliative urinary diversion in patients with advanced malignancy and to compare the results for different malignancies.
METHODS
One hundred three patients with advanced malignancies underwent palliative urinary diversion (stent or nephrostomy) between 1986 and 1997. Ninety‐two patients and 11 patients had bilateral and unilateral obstruction, respectively. Indications, complications, performance status after diversion, and survival for patients with different malignancies were identified and compared. A modified Karnofsky performance scale (KPS) was used for assessment of physical performance. A scale of 0–4 was used: 0) hospitalized until death; 1) bedridden at home, severe pain despite analgesia; 2) moderate disability, moderate pain despite analgesia; 3) mild disability, pain free with medication; and 4) normal.
RESULTS
The mean age of patients was 68 years. The mean pre‐ and postoperative creatinine levels were 6 mg/dL and 3.3 mg/dL, respectively (P < 0.0001). The median survival and days of hospitalization were 112 and 45, respectively. The median postdiversion KPS score was 2 (range, 0–4), and 15% of patients never left the hospital. Overall, 51% required secondary percutaneous procedures, and 68.4% had complications (minor, 63%; major, 5.4%).
CONCLUSIONS
Most patients with advanced cancers had poor performance status and survival after diversion. Eighty six percent had cancer‐related symptoms despite the diversion. The average survival was 5 months, 50% of which was spent in the hospital. Primary endourologic procedures had a high failure rate, and additional procedures were required. Cancer 1999;85:998–1003. © 1999 American Cancer Society.
Endourologic management of malignant ureteral obstruction has a high surgical failure and complication rate. Furthermore, palliative urinary diversion is associated with poor prognosis in terms of survival and performance status after diversion, regardless of the type of malignancy.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - blood</subject><subject>Creatinine - blood</subject><subject>Female</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Hydronephrosis - blood</subject><subject>Hydronephrosis - etiology</subject><subject>Hydronephrosis - surgery</subject><subject>Karnofsky Performance Status</subject><subject>Male</subject><subject>malignancy</subject><subject>malignant ureteral obstruction</subject><subject>Medical sciences</subject><subject>Neoplasm Staging</subject><subject>Neoplasms - blood</subject><subject>Neoplasms - complications</subject><subject>Neoplasms - pathology</subject><subject>Neoplasms - therapy</subject><subject>Nephrostomy, Percutaneous</subject><subject>Palliative Care</subject><subject>palliative urinary diversion</subject><subject>percutaneous nephrostomy</subject><subject>Quality of Life</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the urinary system</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><subject>Ureteral Obstruction - blood</subject><subject>Ureteral Obstruction - etiology</subject><subject>Ureteral Obstruction - surgery</subject><subject>ureteral stent</subject><subject>Urinary Diversion</subject><issn>0008-543X</issn><issn>1097-0142</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkE1v1DAQhi0EotvCX0A5INQestiOE9tbhKgCCytVrIAeKi4jrzMBo3wsdtKq_x5HWT4kkDjZYz0z8_oh5BWjS0Ypf376aVNuzhjVMqVM8FOmtaac5WcqX4kXWqvV6mLzOi3flx8z-jJb0mW5Pefp-h5Z_Gq6TxaUUpXmIrs-IschfIul5Hn2kBzFJZpJRRfkw3YcbN9i0tfJ3jSNM4O7wWT0rjP-Lqli4YPru8R1yfAVk8GjGVrshqnBVDems1glrWncly7eHYZH5EFtmoCPD-cJuVq_uSrfpZfbt5vy4jK1uShoWmVWKyuUFljUhiNWHLUwKreGS8YrVjMUqhByR6UWWihjtd0phVQyhTI7Ic_msXvffx8xDNC6YLFpTIf9GKDQheBU0whez6D1fQgea9h718bPAaMw2QaYbMMkDiZx8NM2qBwERNsA0TbMtiEDCuUWOKzj6CeHDOOuxeqPwbPeCDw9ACZY09R-UhR-czKXWouIfZ6xW9fg3V_5_hvvn-kOL9kPhgWoyg</recordid><startdate>19990215</startdate><enddate>19990215</enddate><creator>Shekarriz, Bijan</creator><creator>Shekarriz, Hodjat</creator><creator>Upadhyay, Jyoti</creator><creator>Banerjee, Mousumi</creator><creator>Becker, Herman</creator><creator>Edson Pontes, J.</creator><creator>Wood, David P.</creator><general>John Wiley & Sons, Inc</general><general>Wiley-Liss</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19990215</creationdate><title>Outcome of palliative urinary diversion in the treatment of advanced malignancies</title><author>Shekarriz, Bijan ; Shekarriz, Hodjat ; Upadhyay, Jyoti ; Banerjee, Mousumi ; Becker, Herman ; Edson Pontes, J. ; Wood, David P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5460-d3c98c4894e6fa2eed2e94a85ca2712d1f1e48647b0794948ac9cb88e0718e73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - blood</topic><topic>Creatinine - blood</topic><topic>Female</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Hydronephrosis - blood</topic><topic>Hydronephrosis - etiology</topic><topic>Hydronephrosis - surgery</topic><topic>Karnofsky Performance Status</topic><topic>Male</topic><topic>malignancy</topic><topic>malignant ureteral obstruction</topic><topic>Medical sciences</topic><topic>Neoplasm Staging</topic><topic>Neoplasms - blood</topic><topic>Neoplasms - complications</topic><topic>Neoplasms - pathology</topic><topic>Neoplasms - therapy</topic><topic>Nephrostomy, Percutaneous</topic><topic>Palliative Care</topic><topic>palliative urinary diversion</topic><topic>percutaneous nephrostomy</topic><topic>Quality of Life</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the urinary system</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><topic>Ureteral Obstruction - blood</topic><topic>Ureteral Obstruction - etiology</topic><topic>Ureteral Obstruction - surgery</topic><topic>ureteral stent</topic><topic>Urinary Diversion</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shekarriz, Bijan</creatorcontrib><creatorcontrib>Shekarriz, Hodjat</creatorcontrib><creatorcontrib>Upadhyay, Jyoti</creatorcontrib><creatorcontrib>Banerjee, Mousumi</creatorcontrib><creatorcontrib>Becker, Herman</creatorcontrib><creatorcontrib>Edson Pontes, J.</creatorcontrib><creatorcontrib>Wood, David P.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shekarriz, Bijan</au><au>Shekarriz, Hodjat</au><au>Upadhyay, Jyoti</au><au>Banerjee, Mousumi</au><au>Becker, Herman</au><au>Edson Pontes, J.</au><au>Wood, David P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcome of palliative urinary diversion in the treatment of advanced malignancies</atitle><jtitle>Cancer</jtitle><addtitle>Cancer</addtitle><date>1999-02-15</date><risdate>1999</risdate><volume>85</volume><issue>4</issue><spage>998</spage><epage>1003</epage><pages>998-1003</pages><issn>0008-543X</issn><eissn>1097-0142</eissn><coden>CANCAR</coden><abstract>BACKGROUND
It is unclear whether palliative endourologic or percutaneous urinary diversion in the treatment of advanced cancer provides significant improvement in quality or duration of life. The purpose of this study was to evaluate survival and performance status after endourologic palliative urinary diversion in patients with advanced malignancy and to compare the results for different malignancies.
METHODS
One hundred three patients with advanced malignancies underwent palliative urinary diversion (stent or nephrostomy) between 1986 and 1997. Ninety‐two patients and 11 patients had bilateral and unilateral obstruction, respectively. Indications, complications, performance status after diversion, and survival for patients with different malignancies were identified and compared. A modified Karnofsky performance scale (KPS) was used for assessment of physical performance. A scale of 0–4 was used: 0) hospitalized until death; 1) bedridden at home, severe pain despite analgesia; 2) moderate disability, moderate pain despite analgesia; 3) mild disability, pain free with medication; and 4) normal.
RESULTS
The mean age of patients was 68 years. The mean pre‐ and postoperative creatinine levels were 6 mg/dL and 3.3 mg/dL, respectively (P < 0.0001). The median survival and days of hospitalization were 112 and 45, respectively. The median postdiversion KPS score was 2 (range, 0–4), and 15% of patients never left the hospital. Overall, 51% required secondary percutaneous procedures, and 68.4% had complications (minor, 63%; major, 5.4%).
CONCLUSIONS
Most patients with advanced cancers had poor performance status and survival after diversion. Eighty six percent had cancer‐related symptoms despite the diversion. The average survival was 5 months, 50% of which was spent in the hospital. Primary endourologic procedures had a high failure rate, and additional procedures were required. Cancer 1999;85:998–1003. © 1999 American Cancer Society.
Endourologic management of malignant ureteral obstruction has a high surgical failure and complication rate. Furthermore, palliative urinary diversion is associated with poor prognosis in terms of survival and performance status after diversion, regardless of the type of malignancy.</abstract><cop>New York</cop><pub>John Wiley & Sons, Inc</pub><pmid>10091780</pmid><doi>10.1002/(SICI)1097-0142(19990215)85:4<998::AID-CNCR30>3.0.CO;2-F</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Cancer, 1999-02, Vol.85 (4), p.998-1003 |
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| language | eng |
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| source | Wiley Free Content; MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Aged Biological and medical sciences Biomarkers - blood Creatinine - blood Female Hospitalization - statistics & numerical data Humans Hydronephrosis - blood Hydronephrosis - etiology Hydronephrosis - surgery Karnofsky Performance Status Male malignancy malignant ureteral obstruction Medical sciences Neoplasm Staging Neoplasms - blood Neoplasms - complications Neoplasms - pathology Neoplasms - therapy Nephrostomy, Percutaneous Palliative Care palliative urinary diversion percutaneous nephrostomy Quality of Life Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system Survival Analysis Treatment Outcome Ureteral Obstruction - blood Ureteral Obstruction - etiology Ureteral Obstruction - surgery ureteral stent Urinary Diversion |
| title | Outcome of palliative urinary diversion in the treatment of advanced malignancies |
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