Iatrogenic ureteral injury during colorectal surgery has a significant impact on patient outcomes: a French multicentric retrospective cohort study - Institut de cancérologie de l'Ouest Access content directly
Journal Articles Colorectal Disease Year : 2023

Iatrogenic ureteral injury during colorectal surgery has a significant impact on patient outcomes: a French multicentric retrospective cohort study

1 AMU SMPM MED - Aix-Marseille Université - École de médecine
2 CRLC Val d'Aurelle-Paul Lamarque
3 IRFAC - Inserm U1113 - Interface de Recherche Fondamentale et Appliquée en Cancérologie
4 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
5 M2iSH - Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte
6 TIMC - Translational Innovation in Medicine and Complexity / Recherche Translationnelle et Innovation en Médecine et Complexité - UMR 5525
7 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
8 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
9 CHU Pitié-Salpêtrière [AP-HP]
10 AMU MED - Aix-Marseille Université - Faculté de médecine
11 Service de Chirurgie Viscérale et Digestive [CHU Caen]
12 ANTICIPE - Unité de recherche interdisciplinaire pour la prévention et le traitement des cancers
13 UNICAEN Santé - Université de Caen Normandie - UFR Santé
14 UCL - Université Catholique de Louvain = Catholic University of Louvain
15 HIFIH - Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques
16 CAP Paris-Tech (UMR_S_1275) - CArcinose Péritoine Paris-Technologies (ex-CART)
17 Hôpital Lariboisière-Fernand-Widal [APHP]
18 Chirurgie digestive [CHU Amiens]
19 SSPC - Simplification des soins chez les patients complexes - UR UPJV 7518
20 SU - Sorbonne Université
21 CHU Saint-Antoine [AP-HP]
22 Service d'Oncologie Médicale [CHRU Besançon]
23 LaTIM - Laboratoire de Traitement de l'Information Medicale
24 LIRIC - Lille Inflammation Research International Center - U 995
25 Hôpital Claude Huriez [Lille]
26 CAPTuR - Contrôle de l’Activation Cellulaire, Progression Tumorale et Résistance thérapeutique
27 Service de Chirurgie digestive, endocrinienne et générale [CHU Limoges]
28 UNICANCER/ICO - Institut de Cancérologie de l'Ouest [Angers/Nantes]
29 NGERE - Nutrition-Génétique et Exposition aux Risques Environnementaux
30 Service de Chirurgie Digestive Hépatobiliaire et Endocrine [CHRU Nancy]
31 Groupe Hospitalier Diaconesses Croix Saint-Simon
32 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
33 Hôpital Trousseau
34 MEPPOT - Médecine personnalisée, pharmacogénomique, optimisation, thérapeutique = Personalized MEdicine, Pharmacogenomics, Therapeutic OPtimization [CRC]
35 Service de Chirurgie Digestive [CHU Rouen]
36 Chirurgie Générale et Digestive [Rangueil]
37 GRECCAR - The French Research Group of Rectal Cancer Surgery = Groupe de Recherche en Chirurgie du Rectum
Philippe Rouanet
Gilles Manceau
Mehdi Ouaissi
  • Function : Author
Maxime Collard
Diane Mege

Abstract

Aim: The long-term urological sequelae after iatrogenic ureteral injury (IUI) during colorectal surgery are not clearly known. The aims of this work were to report the incidence of IUI and to analyse the long-term consequences of urological late complications and their impact on oncological results of IUI occurring during colorectal surgery through a French multicentric experience (GRECCAR group).

Method: All the patients who presented with IUI during colorectal surgery between 2010 and 2019 were retrospectively included. Patients with ureteral involvement needing en bloc resection, delayed ureteral stricture or noncolorectal surgery were not considered.

Results: A total of 202 patients (93 men, mean age 63 ± 14 years) were identified in 29 centres, corresponding to 0.32% of colorectal surgeries (n = 63 562). Index colorectal surgery was mainly oncological (n = 130, 64%). IUI was diagnosed postoperatively in 112 patients (55%) after a mean delay of 11 ± 9 days. Intraoperative diagnosis of IUI was significantly associated with shorter length of stay (21 ± 22 days vs. 34 ± 22 days, p < 0.0001), lower rates of postoperative hydronephrosis (2% vs. 10%, p = 0.04), anastomotic complication (7% vs. 22.5%, p = 0.002) and thromboembolic event (0% vs. 6%, p = 0.02) than postoperative diagnosis of IUI. Delayed chemotherapy because of IUI was reported in 27% of patients. At the end of the follow-up [3 ± 2.6 years (1 month-13 years)], 72 patients presented with urological sequalae (36%). Six patients (3%) required a nephrectomy.

Conclusion: IUI during colorectal surgery has few consequences for the patients if recognized early. Long-term urological sequelae can occur in a third of patients. IUI may affect oncological outcomes in colorectal surgery by delaying adjuvant chemotherapy, especially when the ureteral injury is not diagnosed peroperatively.

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Surgery
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Dates and versions

hal-04113776 , version 1 (22-05-2024)

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Victor Sérénon, Philippe Rouanet, Diane Charleux-Muller, Clarisse Eveno, Karine Poirot, et al.. Iatrogenic ureteral injury during colorectal surgery has a significant impact on patient outcomes: a French multicentric retrospective cohort study. Colorectal Disease, 2023, ⟨10.1111/codi.16630⟩. ⟨hal-04113776⟩
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