Role of Preoperative Ureteric Stenting in Optimization of Patients with Retroperitoneal Tumors Associated with Obstructi
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ORIGINAL ARTICLE
Role of Preoperative Ureteric Stenting in Optimization of Patients with Retroperitoneal Tumors Associated with Obstructive Uropathy Sunirmal Choudhury 1
&
Papiya Biswas 2 & Sayak Roy 3 & Bitan Chatterjee 4,5 & Makhan Lal Saha 4,5
Received: 8 April 2020 / Accepted: 10 November 2020 / Published online: 18 November 2020 # Indian Association of Surgical Oncology 2020
Abstract Retroperitoneal tumors can cause ureteric obstruction leading to obstructive uropathy. Early preoperative ureteric stenting helps to improve renal function and also helps in identifying ureters and prevent ureteric injury during surgery. This study was aimed at assessing the outcome of preoperative stenting in optimizing such patients. A total of 24 cases were enrolled. Of these, 15 patients who had obstructive uropathy were taken for ureteric stenting preoperatively and other 9 patients have undergone surgery without stenting. Twelve patients were stented successfully but 3 patients could not be stented (underwent percutaneous nephrostomy). All 24 patients underwent laparotomy, and of the 12 stented patients, 11 underwent successful resection and one had unresectable tumor. The patient’s serum creatinine was assessed initially and then twice after stenting (48 h and 5 days). Serum creatinine was also estimated 24 h after excision of the tumor. In the successfully stented and operated patients, mean initial creatinine was 7.85. The mean creatinine at 48 h and 5 days after stenting was 4.29 and 1.19 respectively. The mean creatinine 24 h after resection of the tumor was 1.04. Of the non-stented patients, 3 had ureteric injury during surgery. We conclude that preoperative ureteric stenting is helpful for optimization of patients with retroperitoneal tumors with obstructive uropathy. Keywords Retroperitoneal tumor . Obstructive uropathy . Ureteric stenting . Percutaneous nephrostomy
Introduction The retroperitoneum can host a wide spectrum of pathologies, including a variety of rare benign tumors and malignant neoplasms that can be either primary or metastatic lesions. Malignant tumors of the retroperitoneum occur four times more frequently than benign lesions [1]. Retroperitoneal tumor comprises about 10% of all soft tissue tumors [2]. Retroperitoneal tumors are best evaluated using good-quality cross-sectional imaging techniques, and core needle biopsy may be needed when imaging is inconclusive. Complete surgical resection is * Sunirmal Choudhury [email protected] Papiya Biswas [email protected]
the cornerstone of its management [3]. Retroperitoneal tumors present several therapeutic challenges because of their relative late presentation and anatomical location. Patients may present with a large abdominal lump or a dragging pain, which sometimes may be associated with non-specific gastrointestinal symptoms, constitutional symptoms, or pedal edema (due to compression on the inferior vena cava) [4]. In many cases, the retroperitoneal tumor can compress the ureters (unilateral or bilateral) to cause ureteral obstruction
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