European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026
Prophylactic ureteral stenting during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Impact on symptomatic ureteral events requiring renal drainage.
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Chatain Véra, Subtil Fabien, Villeneuve Laurent, Kepenekian Vahan, Glehen Olivier, Ruffion Alain, Descargues Pierre, Bakrin Naoual, Neuville Paul, Arber Théo
Аннотация
BACKGROUND: Ureteral injury during cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is an uncommon but serious complication. The value of prophylactic ureteral stenting remains uncertain.
METHODS: This retrospective monocentric study included patients with Peritoneal Surface Malignancies (PSM) undergoing CRS-HIPEC with ureterolysis and pelvic peritonectomy between 2015 and 2025. Patients were divided according to prophylactic ureteral stent placement. The primary endpoint was the occurrence of a symptomatic ureteral event, defined as a postoperative ureteral fistula or stricture requiring renal drainage. Secondary outcomes included chronic urinary diversion, overall urologic morbidity, and identification of predictive factors associated with ureteral complications.
RESULTS: Among 122 patients, 34 received a prophylactic stent and 88 did not. Symptomatic ureteral events requiring drainage occurred in 14/34 (41.2%) in the STENT group and 31/88 (35.2%) in the No STENT group. Ureteral fistulas occurred in 3/34 (8.8%) versus 15/87 (17.2%) respectively. Postoperative renal drainage occurred in 12/34 (35.3%) in the STENT group, and 30/87 (34.5%) in the No STENT group. Chronic urinary diversion was more frequent among stented patients 13/34 (38.2%) vs 18/88 (20.5%). No significant difference was observed between groups. Prior Surgical Score, Performance status, rectal resection and history of previous pelvic surgeries were associated with increased urologic morbidity.
CONCLUSIONS: Prophylactic ureteral stenting during CRS-HIPEC did not reduce symptomatic ureteral events requiring renal drainage. The stent group showed a trend toward increased chronic urinary diversion. These findings support a selective, risk-based approach based on patient characteristics and surgical complexity.
METHODS: This retrospective monocentric study included patients with Peritoneal Surface Malignancies (PSM) undergoing CRS-HIPEC with ureterolysis and pelvic peritonectomy between 2015 and 2025. Patients were divided according to prophylactic ureteral stent placement. The primary endpoint was the occurrence of a symptomatic ureteral event, defined as a postoperative ureteral fistula or stricture requiring renal drainage. Secondary outcomes included chronic urinary diversion, overall urologic morbidity, and identification of predictive factors associated with ureteral complications.
RESULTS: Among 122 patients, 34 received a prophylactic stent and 88 did not. Symptomatic ureteral events requiring drainage occurred in 14/34 (41.2%) in the STENT group and 31/88 (35.2%) in the No STENT group. Ureteral fistulas occurred in 3/34 (8.8%) versus 15/87 (17.2%) respectively. Postoperative renal drainage occurred in 12/34 (35.3%) in the STENT group, and 30/87 (34.5%) in the No STENT group. Chronic urinary diversion was more frequent among stented patients 13/34 (38.2%) vs 18/88 (20.5%). No significant difference was observed between groups. Prior Surgical Score, Performance status, rectal resection and history of previous pelvic surgeries were associated with increased urologic morbidity.
CONCLUSIONS: Prophylactic ureteral stenting during CRS-HIPEC did not reduce symptomatic ureteral events requiring renal drainage. The stent group showed a trend toward increased chronic urinary diversion. These findings support a selective, risk-based approach based on patient characteristics and surgical complexity.