Outcome of palliative urinary diversion in the treatment of advanced malignancies

BACKGROUND. It is unclear whether palliative endourologic or percutaneous u rinary diversion in the treatment of advanced cancer provides significant i mprovement in quality or duration of life. The purpose of this study was to evaluate survival and performance status after endourologic palliative uri nary diversion in patients with advanced malignancy and to compare the resu lts for different malignancies. METHODS, One hundred three patients with advanced malignancies underwent pa lliative urinary diversion (stent or nephrostomy) between 1986 and 1997. Ni nety-two patients and 11 patients had bilateral and unilateral obstruction, respectively. Indications, complications, performance status after diversi on, and survival for patients with different malignancies were identified a nd compared. A modified Karnofsky performance scale (KPS) was used for asse ssment of physical performance. A scale of 0-4 was used: 0) hospitalized un til death; 1) bedridden at home, severe pain despite analgesia; 2) moderate disability, moderate pain despite analgesia; 3) mild disability, pain free with medication; and 4) normal. RESULTS. The mean age of patients was 68 years. The mean pre- and postopera tive creatinine levels were 6 mg/dL and 3.3 mg/dL, respectively (P < 0.0001 ). The median survival and days of hospitalization were 112 and 45, respect ively. The median postdiversion KPS score was 2 (range, 0-4), and 15% of pa tients never left the hospital. Overall, 51% required secondary percutaneou s procedures, and 68.4% had complications (minor, 63%; major, 5.4%). CONCLUSIONS. Most patients with advanced cancers had poor performance statu s and survival after diversion. Eighty six percent had cancer-related sympt oms despite the diversion. The average survival was 5 months, 50% of which was spent in the hospital. Primary endourologic procedures had a high failu re rate, and additional procedures were required. (C) 1999 American Cancer Society.