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Outcome of palliative urinary diversion in the treatment of advanced malignancies.

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.

journal_name

Cancer

journal_title

Cancer

authors

Shekarriz B,Shekarriz H,Upadhyay J,Banerjee M,Becker H,Pontes JE,Wood DP Jr

doi

10.1002/(sici)1097-0142(19990215)85:4<998::aid-cnc

subject

Has Abstract

pub_date

1999-02-15 00:00:00

pages

998-1003

issue

eissn

0008-543X

issn

1097-0142

pii

10.1002/(SICI)1097-0142(19990215)85:4<998::AID-CNC

journal_volume

pub_type

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Outcome of palliative urinary diversion in the treatment of advanced malignancies.