Abstract
Background: Malignant ureteric obstruction occurs in a variety of cancers and has been typically associated with a poor prognosis. Percutaneous nephrostomy (PCN) can potentially help increase patient longevity by establishing urinary drainage and treating renal failure. Our aim was to look at the outcomes of PCN in patients with advanced cancer and the impact on the patients’ lifespan and quality of life. Materials and Methods: A literature review was carried out for articles from 2000 to 2020 on PCN in patients with advanced malignancies, using MEDLINE, EMBASE, Scopus, CINAHL, Cochrane Library, clinicaltrials.gov, and Google Scholar. All English-language articles reporting on a minimum of 20 patients who underwent PCN for malignancy-associated ureteric obstruction were included. Results: A total of 21 articles (1674 patients) met the inclusion criteria with a mean of 60.2 years (range: 21–102 years). PCN was performed for ureteric obstruction secondary to urological malignancies (n = −633, 37.8%), gynaecological malignancies (n = 437, 26.1%), colorectal and GI malignancies (n = 216, 12.9%), and other specified malignancies (n = 205, 12.2%). The reported mean survival times varied from 2 to 8.5 months post PCN insertion, with an average survival time of 5.6 months, which depended on the cancer type, stage, and previous treatment. Conclusions: Patients with advanced malignancies who need PCN tend to have a survival rate under 12 months and spend a large proportion of this time in the hospital. Although the advent of newer chemotherapy and immunotherapy options has changed the landscape of managing advanced cancer, decisions on nephrostomy must be balanced with their survival and quality of life, which must be discussed with the patient.
Highlights
Malignancy-associated ureteric obstruction occurs in a variety of pelvic cancers, often as a late manifestation, which can be secondary to locally advanced disease or nodal metastases
Patients with advanced malignancies, who present with acute renal failure (ARF) due to malignant ureteric obstruction, are often poor surgical and/or anaesthetic candidates, and Percutaneous nephrostomy (PCN), which can be done under local anaesthesia (LA), is often preferred
We aimed to review the quality of evidence available to date in this group of patients, establishing outcomes of PCN in malignancy-associated ureteric obstruction, assessing the risk of complications, life expectancy, quality of life (QoL) and potential indicators of favourable versus poorer outcomes
Summary
Malignancy-associated ureteric obstruction occurs in a variety of pelvic cancers, often as a late manifestation, which can be secondary to locally advanced disease or nodal metastases. Treatment consists of various options ranging from ureteric stent insertion (retrograde or antegrade), to percutaneous nephrostomy (PCN), to other forms of urinary diversion. While these procedures can help to improve renal function, they risk complications and can have a profound effect on the quality of life (QoL). In the context of locally advanced pelvic cancers, there are often scenarios whereby a patient will start with a retrograde ureteric stent (RUS), but subsequently, as this fails, it necessitates PCN insertion. The advent of newer chemotherapy and immunotherapy options has changed the landscape of managing advanced cancer, decisions on nephrostomy must be balanced with their survival and quality of life, which must be discussed with the patient
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