Abstract
BackgroundIt remains controversial as to whether active stone removal should be performed in patients with poor performance status because of their short life expectancy and perioperative risks. Our objectives were to evaluate treatment outcomes of active stone removal in patients with poor performance status and to compare life prognosis with those managed conservatively.MethodsWe retrospectively reviewed 74 patients with Eastern Cooperative Oncology Group performance status 3 or 4 treated for upper urinary tract calculi at our four hospitals between January 2009 and March 2016. Patients were classified into either surgical treatment group or conservative management group based on the presence of active stone removal. Stone-free rate and perioperative complications in surgical treatment group were reviewed. In addition, we compared overall survival and stone-specific survival between the two groups. Cox proportional hazards analysis was performed to investigate predictors of overall survival and stone-specific survival.ResultsFifty-two patients (70.3%) underwent active stone removal (surgical treatment group) by extracorporeal shock wave lithotripsy (n = 6), ureteroscopy (n = 39), percutaneous nephrolithotomy (n = 6) or nephrectomy (n = 1). The overall stone-free rate was 78.8% and perioperative complication was observed in nine patients (17.3%). Conservative treatment was undergone by 22 patients (29.7%) (conservative management group). Two-year overall survival rates in surgical treatment and conservative management groups were 88.0% and 38.4%, respectively (p < 0.01) and two-year stone-specific survival rates in the two groups were 100.0% and 61.3%, respectively (p < 0.01). On multivariate analysis, stone removal was not significant, but was considered a possible favorable predictor for overall survival (p = 0.07). Moreover, stone removal was the only independent predictor of stone-specific survival (p < 0.01).ConclusionsActive stone removal for patients with poor performance status could be performed safely and effectively. Compared to conservative management, surgical stone treatment achieved longer overall survival and stone-specific survival.
Highlights
It remains controversial as to whether active stone removal should be performed in patients with poor performance status because of their short life expectancy and perioperative risks
Active stone removal for poor performance status (PS) patients is introduced to deal with various problems, such as risks involved in their comorbidities, decreased immune competence, coexisting urinary tract infection and restriction on surgical positioning
Data were collected on the management of any stones, such as active stone removal, including shock wave lithotripsy (SWL), ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL), and observation without operation
Summary
It remains controversial as to whether active stone removal should be performed in patients with poor performance status because of their short life expectancy and perioperative risks. As the rate of aging rises, patients with poor performance status (PS) are expected to increase worldwide. These patients have increased risk of urolithiasis because of various factors, including hypercalciuria associated with osteoporosis, urinary stasis, urinary tract infection and low fluid intake. Active stone removal for poor PS patients is introduced to deal with various problems, such as risks involved in their comorbidities, decreased immune competence, coexisting urinary tract infection and restriction on surgical positioning. It is necessary to investigate whether active stone removal for patients with poor PS is beneficial
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