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Preservation of the mesureter to reduce urinary complications: analysis of data from the observational Leipzig School MMR study
Author(s) -
Wolf B,
Espig O,
Stolzenburg JU,
Horn LC,
Aktas B,
Höckel M
Publication year - 2020
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.16167
Subject(s) - medicine , context (archaeology) , surgery , cervical cancer , retrospective cohort study , dissection (medical) , ureter , urinary system , cervix , percutaneous , bladder cancer , urology , cancer , paleontology , biology
Objective To evaluate the feasibility and effect of mesureteral preservation on urinary complications in the context of total mesometrial resection (TMMR), a surgical treatment for cervical cancer. Design Retrospective cohort study with historic control. Setting Single tertiary academic centre. Population Women older than 18 with primary cervical cancer staged FIGO IB1–IIB enrolled in the prospective Leipzig School MMR study and underwent total mesometrial resection (TMMR) without adjuvant radiation. Method We retrospectively analysed 100 consecutive TMMR procedures which were performed for cancer of the uterine cervix and in which the mesureter was preserved (intervention group, 01/2014–06/2017). We compared this group with the previous 100 consecutive TMMRs, which were performed before the introduction of mesureteral preservation (control group, 09/2010–01/2014). Main outcome measures The occurrence of urological and specifically ureteral complications. Results Mesureteral preservation was feasible and was associated with a significant decrease in ureteral complications (11% without mesureteral preservation versus 3% with mesureteral preservation, P = 0.049). Furthermore, we found a significant decrease in the number of postoperative percutaneous nephrostomies and re‐operations (7% versus none, P = 0.014). There was also a trend towards a decrease in other urinary complications such as postoperative bladder atony and uretero‐vaginal fistulas. Conclusion The mesureter constitutes a convenient dissection plane enabling the preservation of lateral ureteral blood supply during TMMR. In our study, maintenance of mesureteral integrity was associated with a significant reduction in ureteral complications. Mesureteral preservation might also be useful in other types of pelvic surgeries that carry a high risk of ureteral damage. Tweetable abstract Surgical preservation of the mesureter in cervical cancer patients was associated with a reduction in urinary complications.